MR. JEFFERSON WILBURN JR. MOORE (APN) – Adult Health Nurse Practitioner, NPI 1104128867

MR. JEFFERSON WILBURN JR. MOORE (APN) is a healthcare provider. based in Batesville, Arkansas. specializing in NURSE PRACTITIONER. They hold the professional credentials APN. They hold a License No. ATP-000312 (AR). The NPI Number for MR. JEFFERSON WILBURN JR. MOORE (APN) is 1104128867

Main info

Male
Sole Proprietor
16 Years Of Experience
Accepts Medicare Assignment
Name
MR. JEFFERSON WILBURN JR. MOORE (APN)
NPI
1104128867
Phone
(870) 262-1338
Address
1710 HARRISON ST
Enumeration Date
30 November 2010
Last Update Date
30 November 2010

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8707937519
Graduation Year
2010 (16 years ago)
PAC ID
9133301005
Group Practice PAC ID
0143134270
Professional Enrollment ID
I20110314000870
Address ID
AR725017343BA16XXXCIRX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience44
Completeness75
Years active:15State licenses:1Digital endpointsOther names

3,410 NURSE PRACTITIONER in AR

Provider Addresses for MR. JEFFERSON WILBURN JR. MOORE (APN)

  • 1710 HARRISON ST

    BATESVILLE, AR 725017303

    Phone: (870) 262-1338

    Fax: (870) 262-1336

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

Open Payments (CMS)

CMS reports 32 Open Payments records for all available years, with a total value of $591.

Total Amount is formed as General ($591) + Research ($0) + Ownership ($0) = $591.

Last reported payment date: 2024-11-04 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($124).

Total Amount

$591

General + Research + Ownership

Payments

32

Total payment records

General Amount

$591

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-04

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2011-03-14

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20110314000870INurse PractitionerARTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes560327$0
99213Established patient office or other outpatient visit, 20-29 minutes495327$0
93010Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only188152$0
93288Evaluation of single, dual, multiple lead or leadless pacemaker system1312$0
View full utilization report →

Insurance plans in this area (ZIP 72501)

Loading plans...

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0143134270View full group profile

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Can I cross-check MR. JEFFERSON WILBURN JR. MOORE (APN) using NPI 1104128867?
NPI 1104128867 belongs to MR. JEFFERSON WILBURN JR. MOORE (APN); compare other details if you need extra assurance.
Active or inactive — what applies to MR. JEFFERSON WILBURN JR. MOORE (APN)?
You should see MR. JEFFERSON WILBURN JR. MOORE (APN) as active in CMS-hosted NPPES data.
What expertise is attributed to MR. JEFFERSON WILBURN JR. MOORE (APN)?
MR. JEFFERSON WILBURN JR. MOORE (APN)'s specialty line reads Adult Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What practice footprint exists for MR. JEFFERSON WILBURN JR. MOORE (APN)?
Travel planning: use Batesville, Arkansas as the reference point for MR. JEFFERSON WILBURN JR. MOORE (APN), then confirm.
What does 2 location(s) imply?
2 practice locations appear in the available data.

Similar Providers

CYNTHIA ELAINE JACKSON (APN)

Adult Health Nurse Practitioner
3443 HARRISON ST
NPI: 1073891040

DIEDRA LYNN STRECKER (APN)

Adult Health Nurse Practitioner
1225 DOGWOOD DR
NPI: 1356706410

MR. LEROY JR. MAUPIN (APRN)

Adult Health Nurse Practitioner
407, Virginia Drive, Batesville, Independence County, Arkansas, 72501, United States
NPI: 1003355447