Provider Demographics
NPI:1225452873
Name:MOSS, REBECCA C (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:MOSS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3126 S JACKSON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2534
Mailing Address - Country:US
Mailing Address - Phone:417-781-0408
Mailing Address - Fax:417-627-8738
Practice Address - Street 1:3126 S JACKSON AVE
Practice Address - Street 2:STE 101
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2534
Practice Address - Country:US
Practice Address - Phone:417-781-0408
Practice Address - Fax:417-627-8738
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014002628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily