Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jaden Rene Moomaw

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1376298919

Jaden Rene Moomaw is a Nurse Practitioner in Mattoon, Illinois. Qualified in 2023, 3 years ago. Practices with Carle Health Care Incorporated, a 1,543-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
3
Licensed in
IL
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

2512 Hurst Dr Ste 120
Mattoon, IL 61938-9200
Phone: (217) 258-7590
Fax: (217) 258-3686
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 6 Hairpin Dr, Edwardsville, IL 62026-1000 — (618) 650-3956

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 209027942 (IL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1376298919
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 12, 2022
Last updated in NPPESFebruary 29, 2024
Certification dateFebruary 29, 2024
Mailing address2512 Hurst Dr Ste 120, Mattoon, IL 61938-9200

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Carle Health Care Incorporated — 1543 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Mattoon