KELLEY B MOULE MSW, LMSW
NPI 1689984916
Social Worker - Clinical in Jackson, MS

Active since October 20, 2010PECOS EnrolledAccepts Medicare Assignment
911 ELLIS AVE, JACKSON, MS 39209(601) 533-7016 Get Directions Write a Review

NPPES record last updated: November 13, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 13, 2024, Jan 13, 2023, Sep 21, 2021 (3 updates tracked since 2021).

About Kelley B Moule Msw, Lmsw NPPES

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

KELLEY B MOULE MSW, LMSW (NPI 1689984916) is an individual clinical provider in Jackson, Mississippi, licensed in Mississippi (C9980) and active in the NPI registry since October 2010. She is enrolled in Medicare PECOS, maintains 5 additional practice locations, and is a graduate of Other (2008).

NPPES Registry Identity

NPI1689984916
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKELLEY B MOULECredential: MSW, LMSW
Location Address911 ELLIS AVEJackson, MS 39209-6256
Mailing AddressPo Box 746085Atlanta, GA 30374-6085 · (773) 352-1515 · Fax (312) 929-0373
Sole ProprietorNo
Medical School CMSOtherGraduated 2008
Enumeration DateOctober 20, 2010
Last NPPES UpdateNovember 13, 20243 updates tracked since enumeration
NPPES CertifiedNovember 13, 2024
NPI 1689984916 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License Licensed in MS · C9980
Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 9101 (SC)
911 ELLIS AVE, Jackson, MS 39209

Secondary Practice Locations 5

Location 1301 Palmetto Park BlvdLexington, SC 29072-7872 · Phone (803) 996-1500 · Fax (803) 996-1510
Location 21 Medical Plaza Dr Ste BVicksburg, MS 39180-5187 · Phone (205) 246-5690
Location 33600 Bluecutt Rd Ste 202Columbus, MS 39705-1397 · Phone (205) 246-5690
Location 41200 N State St Ste 455Jackson, MS 39202-2000 · Phone (601) 957-7343
Location 54541 N State StJackson, MS 39206-5308 · Phone (601) 533-7017

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Kelley B Moule Msw, Lmsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6800293226
PECOS Enrollment IDI20210927002505
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 39209 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
$0.00 typical visit price
range $51.65 – $159.18
Typical copayment $0.00 (range $12.91 – $39.79)
Most-billed visit code NA
Established Patient
$64.96 typical visit price
range $16.15 – $129.61
Typical copayment $16.24 (range $4.03 – $32.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

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

Nurse Practitioner (Family)
911 ELLIS AVE
JACKSON, MS 39209
Family Medicine
911 ELLIS AVE
JACKSON, MS 39209
Nurse Practitioner (Family)
911 ELLIS AVE
JACKSON, MS 39209
Nurse Practitioner
911 ELLIS AVE
JACKSON, MS 39209
Nurse Practitioner (Family)
911 ELLIS AVE
JACKSON, MS 39209
Nurse Practitioner (Family)
911 ELLIS AVE
JACKSON, MS 39209
Internal Medicine
911 ELLIS AVE
JACKSON, MS 39209
Nurse Practitioner (Family)
911 ELLIS AVE
JACKSON, MS 39209

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 Kelley Moule's NPI number?

The NPI number for Kelley Moule is 1689984916. It was assigned to this individual provider in the NPPES registry on October 20, 2010.

Where is Kelley Moule located?

Kelley Moule practices at 911 Ellis Ave, Jackson, MS 39209. The listed phone number is (601) 533-7016.

What is Kelley Moule's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kelley Moule enrolled in Medicare?

Yes. Kelley Moule is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Kelley Moule was last updated on November 13, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.