Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Sara Jane Moore, AGACNP

Individual provider Acute Care Nurse Practitioner · NPI 1487204558

Mrs. Sara Jane Moore, AGACNP is a Nurse Practitioner in Grand Rapids, Michigan. Qualified in 2019, 7 years ago. Practices with Kent Radiology PC, an 18-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
7
Licensed in
MI
In the registry since
2019
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Practice location Address checks out

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone: (616) 914-1693
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 4704265117 (MI)

Record details

NPI number1487204558
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGACNP
Sole proprietorYes
NPI enumeratedSeptember 19, 2019
Last updated in NPPESOctober 8, 2019

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Kent Radiology Pc — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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