Provider Demographics
NPI:1225512478
Name:MOSS, KELLY NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:MOSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:NICOLE
Other - Last Name:SEBZDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:601 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1443
Mailing Address - Country:US
Mailing Address - Phone:484-628-8900
Mailing Address - Fax:610-375-1203
Practice Address - Street 1:601 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1443
Practice Address - Country:US
Practice Address - Phone:484-628-8900
Practice Address - Fax:610-375-1203
Is Sole Proprietor?:No
Enumeration Date:2018-09-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical