Provider Demographics
NPI:1720396674
Name:MOSES, MATTHEW S (APRN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:S
Last Name:MOSES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 W BUSINESS HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 N ONE MILE RD STE 3
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1001
Practice Address - Country:US
Practice Address - Phone:573-624-7575
Practice Address - Fax:573-624-3157
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily