Provider Demographics
NPI:1053503458
Name:MOULIN, JOSH CHARLES (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:CHARLES
Last Name:MOULIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 W KANSAS
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67054
Mailing Address - Country:US
Mailing Address - Phone:620-723-4217
Mailing Address - Fax:620-508-2067
Practice Address - Street 1:721 W KANSAS
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KS
Practice Address - Zip Code:67054
Practice Address - Country:US
Practice Address - Phone:620-723-4217
Practice Address - Fax:620-508-2067
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST01460282NR1301X
KS1501214363A00000X
KS15-01214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS427174OtherMEDICARE ID UNSPECIFIED
KS200439900AMedicaid