Provider Demographics
NPI:1720023708
Name:MOSS, HEATHER KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KATHERINE
Last Name:MOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 ALCOA HWY STE B300
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1505
Mailing Address - Country:US
Mailing Address - Phone:865-305-9799
Mailing Address - Fax:
Practice Address - Street 1:4005 FOUNTAIN VALLEY DR
Practice Address - Street 2:SUITE 450
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-5327
Practice Address - Country:US
Practice Address - Phone:865-922-5870
Practice Address - Fax:865-922-5872
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39160207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3333707Medicaid
TN3333707Medicaid
TNH33431Medicare UPIN