Provider Demographics
NPI:1093999054
Name:MOSES, KAREN MCCOMB (NP-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MCCOMB
Last Name:MOSES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LINDSAY
Other - Last Name:MCCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:836 E 65TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4491
Mailing Address - Country:US
Mailing Address - Phone:912-354-6187
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-354-6187
Practice Address - Fax:912-355-9807
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173580363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003114064GMedicaid
GARN173580OtherMEDICAL LICENSE