Provider Demographics
NPI:1184180267
Name:MOSER, KARA MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:MICHELLE
Last Name:MOSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KARA
Other - Middle Name:MICHELLE
Other - Last Name:KINNISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:701 S. NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-8850
Mailing Address - Fax:
Practice Address - Street 1:701 S. NEW BALLAS ROAD
Practice Address - Street 2:SUITE 330
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019004434363A00000X
NY023268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMA4057Medicaid