Provider Demographics
NPI:1497146294
Name:MOSS, STARLITA (PA-C)
Entity Type:Individual
Prefix:DR
First Name:STARLITA
Middle Name:
Last Name:MOSS
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 1:3281 N DECATUR BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3264
Mailing Address - Country:US
Mailing Address - Phone:702-800-8988
Mailing Address - Fax:702-800-8998
Practice Address - Street 1:3281 N DECATUR BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3264
Practice Address - Country:US
Practice Address - Phone:702-800-8988
Practice Address - Fax:702-800-8998
Is Sole Proprietor?:No
Enumeration Date:2015-02-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA17019363A00000X
IL085005339363A00000X
NVPA1719363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA0565OtherSTATE LICENSE
NVPA1719OtherSTATE LICENSE
NV1497146294Medicaid