JACLYN MOORE (NPI# 1679739759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679739759 |
| Entity Type | Individual |
| Full Name | JACLYN MOORE |
| Practice Address |
19401 Northline Rd Southgate MI 48195-2277 |
| Mailing Address |
2084 Cicotte Ave Lincoln Park MI 48146-1309 |
| Practice Telephone | 7347857718 |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2008-07-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3747P1801X |
Technician Specialization: Personal Care Attendant |
Nursing Service Related Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629684907 | Jaclyn Vaughn Moore | Dietitian, Registered | 234 E Gray St Ste 164, Louisville, KY 40202-1903 | 2020-09-22 |
| 1992186506 | Jaclyn Moore | Counselor | 2577 S Five Mile Rd Ste 101, Boise, ID 83709 | 2015-06-10 |
| 1114428364 | Jaclyn Marie Moore | Occupational Therapist | 10000 Telegraph Rd, Taylor, MI 48180-3330 | 2018-02-23 |
| 1992137848 | Jaclyn M Moore | Licensed Practical Nurse | 777 37th St, Suite B107, Vero Beach, FL 32960-4873 | 2013-08-02 |
| 1073669354 | Jaclyn Lee Moore | Pharmacist | 67-1185 Mamalahoa Hwy, Kamuela, HI 96743-7304 | 2007-01-26 |
| Street Address |
19401 NORTHLINE RD |
| City | SOUTHGATE |
| State | MI |
| Zip Code | 48195-2277 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912922410 | Michael Chapman | Counselor | 19401 Northline Rd, Southgate, MI 48195-2277 | 2006-07-13 |
| 1992334833 | Terrie Upham | Social Worker | 19401 Northline Rd, Southgate, MI 48195-2277 | 2020-04-03 |
| 1831729953 | Susie Dianna Rankin | Social Worker | 19401 Northline Rd, Southgate, MI 48195-2277 | 2020-01-16 |
| 1861031916 | Brianna R Simmons | Case Manager/Care Coordinator | 19401 Northline Rd, Southgate, MI 48195-2277 | 2020-01-06 |
| 1134771678 | Micheline Silva | Social Worker | 19401 Northline Rd, Southgate, MI 48195-2277 | 2019-07-15 |
| 1730645003 | Sara Swanson | Counselor | 19401 Northline Rd, Southgate, MI 48195-2277 | 2019-02-12 |
| 1366906893 | Katelyn Rose Slominski | Case Manager/Care Coordinator | 19401 Northline Rd, Southgate, MI 48195-2277 | 2019-01-29 |
| 1295287829 | Vanessa Montemayor | Case Manager/Care Coordinator | 19401 Northline Rd, Southgate, MI 48195-2277 | 2016-10-31 |
| 1659824746 | Kourtni Moncrease | Case Manager/Care Coordinator | 19401 Northline Rd, Southgate, MI 48195-2277 | 2016-07-26 |
| 1154874188 | Amber Nolan | Social Worker | 19401 Northline Rd, Building 5, Southgate, MI 48195-2277 | 2016-07-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780206656 | Destiny D Harris | Social Worker | 14799, Southgate, MI 48195 | 2020-05-13 |
| 1285102368 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 16256 Fort St, Southgate, MI 48195 | 2018-11-07 |
| 1003382979 | Saran Charisse Watts | Case Manager/Care Coordinator | 31101 Allen Rd, Building 5, Southgate, MI 48195 | 2018-10-18 |
| 1255824025 | Kiesta Janell Lindsey | Social Worker | 13101 Allen Rd Bldg 4-f, Southgate, MI 48195 | 2018-06-07 |
| 1417473224 | Suzette Michele Watson | Nurse Practitioner | 14319 Dix-toledo, Southgate, MI 48195 | 2017-08-15 |
| 1275069486 | Liza Du Plessis | Student in an Organized Health Care Education/Training Program | 13111 Allen Road, Southgate, MI 48195 | 2017-05-08 |
| 1497290456 | Beaumont Health | Clinic/Center | 15777 Northline, Southgate, MI 48195 | 2016-12-30 |
| 1184172876 | Felicia Wilson | Licensed Practical Nurse | 15771 Wildemere, Southgate, MI 48195 | 2016-09-12 |
| 1225487978 | Stacey Petrick-strickland | Technician, Other | 12189 Agnes, Southgate, MI 48195 | 2016-06-03 |
| 1205298486 | Ashley Francis | Hearing Instrument Specialist | 18800 Eureka Rd., Southgate, MICHIGAN 48195 | 2016-03-25 |
| Find all providers in zip 48195 | ||||
| Taxonomy Code | 3747P1801X |
| Grouping | Nursing Service Related Providers |
| Classification | Technician |
| Specialization | Personal Care Attendant |
| An individual who provides assistance with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards |
| Notes: [7/1/2003: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841544046 | Crystal Kidd | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-11-09 |
| 1518210624 | Trina Peguese | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-10-26 |
| 1740533843 | Jennifer Jones | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-10-26 |
| 1376896464 | James Ellsworth | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-10-26 |
| 1366794448 | Victor Reyes | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-10-12 |
| 1205188380 | Madison Goold | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-10-12 |
| 1023360187 | Renee Samples | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-10-12 |
| 1497007975 | Victoria Green | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-10-09 |
| 1689925778 | Rene Demery | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-09-28 |
| 1417208695 | Kathryn Barill | Technician | 19401 Northline Rd, Southgate, MI 48195-2277 | 2012-09-27 |
| Find all providers in SOUTHGATE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.