MEDICARE: MRS. NICOLE JONES MOORE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	903302	MS

General Provider Information

NPI Number	:	1245890144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE JONES MOORE NP

Provider Business Mailing Address
First Line	:	16 RIVIERA CIR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-8682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 E HOSPITAL DR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1310
Country	:	US
Telephone Number	:	601-475-9968
Fax Number	:	601-475-9969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	04/13/2026

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