DR. SHANNON MONIQUE MOORE PHD
NPI 1154636611
Psychologist - Clinical in Jackson, MS

Q: What is Shannon Moore's NPI number?

The NPI number for Shannon Moore is 1154636611. It was assigned to this individual provider in the NPPES registry on August 9, 2010.

Q: What is Shannon Moore's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Shannon Moore was last updated on March 22, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 09, 2010PECOS Enrolled

1675 LAKELAND DR STE 304, JACKSON, MS 39216(769) 524-4578(769) 524-4630 Get Directions Write a Review

NPPES record last updated: March 22, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 22, 2019, Nov 13, 2017 (2 updates tracked since 2017).

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About Dr. Shannon Monique Moore Phd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SHANNON MONIQUE MOORE PHD (NPI 1154636611) is an individual clinical provider in Jackson, Mississippi, licensed in Mississippi (55981) and active in the NPI registry since August 2010. She is enrolled in Medicare PECOS and maintains a secondary practice location in Nashville.

NPPES Registry Identity

NPI1154636611

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDR. SHANNON MONIQUE MOORECredential: PHD

Location Address1675 LAKELAND DR STE 304Jackson, MS 39216

Mailing AddressPo Box 13563Jackson, MS 39236-3563 · (769) 524-4578 · Fax (769) 524-4630

Phone(769) 524-4578

Fax(769) 524-4630

Sole ProprietorYes

Enumeration DateAugust 9, 2010

Last NPPES UpdateMarch 22, 20192 updates tracked since enumeration

✔ NPI 1154636611 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MS · 55981

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

1675 LAKELAND DR STE 304, Jackson, MS 39216

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Secondary Practice Location 1

Location 11818 Albion St Ste 114Nashville, TN 37208-2918 · Phone (615) 327-4751 ext. 63221

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Shannon Monique Moore Phd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 39216 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$159.18 typical visit price

range $51.65 – $159.18

Typical copayment $39.79 (range $12.91 – $39.79)

Most-billed visit code 99205

Established Patient

$92.20 typical visit price

range $16.15 – $129.61

Typical copayment $23.05 (range $4.03 – $32.40)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shannon Moore's NPI number?

The NPI number for Shannon Moore is 1154636611. It was assigned to this individual provider in the NPPES registry on August 9, 2010.

Where is Shannon Moore located?

Shannon Moore practices at 1675 Lakeland Dr Ste 304, Jackson, MS 39216. The listed phone number is (769) 524-4578.

What is Shannon Moore's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Shannon Moore enrolled in Medicare?

Yes. Shannon Moore is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Shannon Moore was last updated on March 22, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.