Provider Demographics
NPI:1013788678
Name:MOSSER, KAYLA KIPP (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:KIPP
Last Name:MOSSER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 GOLD HILL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8907
Mailing Address - Country:US
Mailing Address - Phone:803-802-5900
Mailing Address - Fax:
Practice Address - Street 1:704 GOLD HILL RD STE 207
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8907
Practice Address - Country:US
Practice Address - Phone:803-802-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28162363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner