Provider Demographics
NPI:1013618776
Name:MOSS, JESSICA LEE (FNP, RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:MOSS
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:PA
Mailing Address - Zip Code:16343-0104
Mailing Address - Country:US
Mailing Address - Phone:814-516-3286
Mailing Address - Fax:
Practice Address - Street 1:813 OAK ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:PA
Practice Address - Zip Code:16343-1039
Practice Address - Country:US
Practice Address - Phone:814-516-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner