Provider Demographics
NPI:1093445843
Name:MOSS, KELLY FRANCES (DNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:FRANCES
Last Name:MOSS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 OVERLOOK DR NE APT 155
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-4306
Mailing Address - Country:US
Mailing Address - Phone:941-448-0860
Mailing Address - Fax:
Practice Address - Street 1:508 S HABANA AVE STE 160
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4190
Practice Address - Country:US
Practice Address - Phone:813-708-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF10201315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily