MS. MARSHA ANN MOORE, NP - NPI NUMBER 1396813598

Summary

Provider Name: MS. MARSHA ANN MOORE, NP

NPI Number: 1396813598

Clasification: Nurse Practitioner (363L00000X)

Organization: MINERS' COLFAX MEDICAL CENTER

Address:
142 S 1ST ST
RATON, NM
ZIP 87740

Phone Number: (575) 445-2753



Detailed Information

MS. Marsha Ann Moore, NP is a nurse practitioner in Raton, NM with 17 years of experience. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. The assigned NPI number for this provider is 1396813598 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

142 S 1ST ST
RATON, NM
ZIP 87740-902
Phone: (575) 445-2753
Fax: (575) 445-2759

The enumeration date for this NPI number is 12/4/2006 and was last updated on 1/8/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363L00000X Nurse Practitioner R38356 NM Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 S36035 MEDICARE UPIN NM
2 00071062 MEDICAID NM

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1396813598 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name MOORE The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name MARSHA The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
5 Provider Middle Name ANN Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
6 Provider Name Prefix Text MS. The last name of the provider. If the provider is an individual, this is the legal name.
7 Provider Credential Text NP The first name of the provider, if the provider is an individual.
8 Provider First Line Business Practice Location Address 142 S 1ST ST The middle name of the provider, if the provider is an individual.
9 Provider Business Practice Location Address City Name RATON The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
10 Provider Business Practice Location Address State Name NM The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
11 Provider Business Practice Location Address Postal Code 877403902 The city name in the location address of the provider being identified.
12 Provider Business Practice Location Address Country Code If outside U S US The State code in the location of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 5754452753 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
14 Provider Business Practice Location Address Fax Number 5754452759 The country code in the location address of the provider being identified.
15 Provider Enumeration Date 12/4/2006 The telephone number associated with the location address of the provider being identified.
16 Last Update Date 1/8/2013 The date that a record was last updated or changed.
17 Provider Gender Code F The code designating the provider’s gender if the provider is a person.
18 Healthcare Provider Taxonomy Code 1 363L00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 R38356 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 1 NM The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 S36035 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier Type Code 1 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier State 1 NM
25 Other Provider Identifier 2 00071062 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier State 2 NM
28 Is Sole Proprietor Y Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 2/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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