Provider Demographics
NPI:1558332981
Name:MOSER, ANDREA D (PA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:D
Last Name:MOSER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 N SANTA FE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7536
Mailing Address - Country:US
Mailing Address - Phone:405-231-8740
Mailing Address - Fax:405-231-8714
Practice Address - Street 1:6205 N SANTA FE AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118
Practice Address - Country:US
Practice Address - Phone:405-231-8740
Practice Address - Fax:405-231-8714
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1433363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ40189Medicare UPIN
OK248509808Medicare ID - Type Unspecified