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JACQUELINE H MODER
NPI 1568071777
Nurse Practitioner in Waycross, GA

Active since July 24, 2020
1912 MEMORIAL DR STE E, WAYCROSS, GA 31501(912) 283-7100 Get Directions Write a Review

NPPES record last updated: July 24, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jacqueline H Moder NPPES

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

JACQUELINE H MODER (NPI 1568071777) is an individual nurse practitioner in Waycross, Georgia, licensed in Georgia (RN240089) and active in the NPI registry since July 2020.

NPPES Registry Identity

NPI1568071777
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameJACQUELINE H MODER
Location Address1912 MEMORIAL DR STE EWaycross, GA 31501-0989
Mailing Address6115 Cottonwood LnBlackshear, GA 31516-5992 · (912) 286-4400
Phone(912) 283-7100
Sole ProprietorNo
Enumeration DateJuly 24, 2020
NPPES CertifiedJuly 24, 2020
✔ NPI 1568071777 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Licenses✔ Licensed in GA · RN240089✔ Licensed in FL · 11006710
Definition
(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.
1912 MEMORIAL DR STE E, Waycross, GA 31501
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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANTHONY AARON BRYSON
Nurse Practitioner (Family)
1912 MEMORIAL DR STE E
WAYCROSS, GA 31501
Ware County (912) 283-7100
SUMMER DIXON HILL
Nurse Practitioner (Family)
1912 MEMORIAL DR STE E
WAYCROSS, GA 31501
Ware County (912) 283-7100

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 Jacqueline Moder's NPI number?

The NPI number for Jacqueline Moder is 1568071777. It was assigned to this individual provider in the NPPES registry on July 24, 2020.

Where is Jacqueline Moder located?

Jacqueline Moder practices at 1912 Memorial Dr Ste E, Waycross, GA 31501. The listed phone number is (912) 283-7100.

What is Jacqueline Moder's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

When was this NPI record last updated?

The NPPES record for Jacqueline Moder was last updated on July 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.