Provider Demographics
NPI:1184000820
Name:MOSES, JEREMY (PA-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MOSES
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 1:800 N JUSTICE ST # 16
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3410
Mailing Address - Country:US
Mailing Address - Phone:828-694-8350
Mailing Address - Fax:828-694-7654
Practice Address - Street 1:1824 PISGAH DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3759
Practice Address - Country:US
Practice Address - Phone:828-694-8427
Practice Address - Fax:828-694-8428
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05865363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19ELCOtherBCBS NC
NCP01548044OtherRR MEDICARE
NCNCP403AOtherMEDICARE PTAN