Provider Demographics
NPI:1790399350
Name:MOSS, RACHEL REYNOLDS (CRNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:REYNOLDS
Last Name:MOSS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP, RN
Mailing Address - Street 1:46 L V STABLER DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3865
Mailing Address - Country:US
Mailing Address - Phone:334-382-9760
Mailing Address - Fax:334-383-9331
Practice Address - Street 1:46 L V STABLER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3865
Practice Address - Country:US
Practice Address - Phone:334-382-9760
Practice Address - Fax:334-383-9331
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily