Provider Demographics
NPI:1417006115
Name:MOSER, MELISSA R (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:R
Last Name:MOSER
Suffix:
Gender:F
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:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:
Practice Address - Street 1:140 LEANING OAK DR STE 101
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6991
Practice Address - Country:US
Practice Address - Phone:704-658-9730
Practice Address - Fax:704-658-1457
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500264363A00000X
NC0010-00315363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q76127Medicare UPIN
2769730AMedicare PIN