MR. JEFFREY R. MOFFETT (NPI# 1710135629) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710135629 |
| Entity Type | Individual |
| Full Name | MR. JEFFREY R. MOFFETT |
| Credential | FNP |
| Practice Address |
3115 Audubon Dr Laurel MS 39440 |
| Mailing Address |
3115 Audubon Dr Laurel MS 39440-1913 |
| Practice Telephone | 6015312200 |
| Practice Fax Number | 6015312220 |
| Mailing Telephone | 6015312200 |
| Mailing Fax Number | 6015312220 |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2019-04-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | R872112 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00753295 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3115 Audubon Dr, Laurel, MS 39440 | 6015312200 | 6015312220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588745228 | Jeffrey Victor Moffett | Dentist | 275 Bayshore Blvd, 805, Tampa, FL 33606-2328 | 2006-10-18 |
| 1447257985 | Jeffrey Dean Moffett | Orthopaedic Surgery | 2535 Ira E Woods Ave, Grapevine, TX 76051-3930 | 2005-06-30 |
| Street Address |
3115 AUDUBON DR |
| City | LAUREL |
| State | MS |
| Zip Code | 39440 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265921985 | North Laurel Family Medicine, LLC | Nurse Practitioner | 3115 Audubon Dr, Laurel, MS 39440 | 2018-05-08 |
| 1144532086 | Michael Douglas Collins | Nurse Practitioner | 3115 Audubon Dr, Laurel, MS 39440 | 2010-07-08 |
| 1033350632 | Unlimited Dreams II | Hospice Care, Community Based | 3115 Audubon Dr, Laurel, MS 39440-1913 | 2009-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306323159 | Tender Loving Care Homecare LLC | Homemaker | 509 Central Ave Ste 224, Laurel, MS 39440 | 2018-07-24 |
| 1669837910 | Laurel Dental Properties | Dentist | 1925 Pine Belt Drive, Laurel, MS 39440 | 2015-12-30 |
| 1215282991 | South Central Regional Medical Center | Clinic/Center | 525 Wayne Drive, Laurel, MS 39440 | 2012-07-18 |
| 1568721215 | Terry Ratcliff Perkins | Counselor | 5192 Hwy 11 North, Laurel, MS 39440 | 2012-05-15 |
| 1437453057 | Alexander Milne Home for Women | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 616 East 19th Street, Laurel, MS 39440 | 2010-12-23 |
| 1003096785 | Family Health Center, Inc | Obstetrics & Gynecology | 103 S. 12th Avenue, Laurel, MS 39440 | 2007-11-09 |
| 1669672143 | Laurel Urology Clinic Pa | Urology | 304 S 10th Ave, Laurel, MS 39440 | 2007-07-23 |
| 1093912370 | Tanweer Hussain Majid | Surgery | 1007 Jefferson Street, Laurel, MS 39440 | 2007-06-29 |
| 1780889923 | Hattiesburg Eye Clinic, Pa | Ophthalmology | 1431 North 10th St, Suite 1, Laurel, MS 39440 | 2007-06-18 |
| 1043421464 | K's Discount Drugs | Pharmacist | 30 Circle J Drive, Suite #2, Laurel, MS 39440 | 2007-05-25 |
| Find all providers in zip 39440 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (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. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114583184 | Patricia E. Asagaya | Nurse Practitioner | 14302 Stroud Ct, Laurel, MD 20707-9502 | 2019-05-15 |
| 1043686876 | Akukeng Mba | Nurse Practitioner | 13208 Deerfield Rd, Laurel, MD 20708-2005 | 2015-08-16 |
| 1174829733 | Kimberly Cabe | Nurse Practitioner | 601 N 15th Ave, Laurel, MS 39440-3839 | 2011-01-31 |
| 1427069418 | Modupe A. Apassa | Nurse Practitioner | 13932 Baltimore Ave, Laurel, MD 20707-5000 | 2006-08-11 |
| 1013567445 | Jessica Watson Lott | Nurse Practitioner | 404 S 13th Ave, Laurel, MS 39440-4345 | 2019-09-17 |
| 1376198697 | Momoh Makieu | Nurse Practitioner | 13994 Baltimore Ave Ste 102, Laurel, MD 20707-5087 | 2019-08-04 |
| 1881253557 | Sarah M Wooten | Nurse Practitioner | 1220 Jefferson St, Laurel, MS 39440-4355 | 2019-06-06 |
| 1982195137 | Erica Windham | Nurse Practitioner | 1220 Jefferson St, Laurel, MS 39440 | 2018-05-23 |
| 1265921985 | North Laurel Family Medicine, LLC | Nurse Practitioner | 3115 Audubon Dr, Laurel, MS 39440 | 2018-05-08 |
| 1730605593 | Brittany Poole Jones | Nurse Practitioner | 30 Circle J Dr Ste 1, Laurel, MS 39440-1981 | 2017-08-14 |
| Find all providers in LAUREL | ||||
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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.