Provider Demographics
NPI:1255756961
Name:MOSMAN, AMY KRIEG (MMS, PA-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:KRIEG
Last Name:MOSMAN
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LEEANN
Other - Last Name:KRIEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMS, PA-C
Mailing Address - Street 1:3635 VISTA AVE
Mailing Address - Street 2:FLOOR 9 - DIVISION OF NEPHROLOGY
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-977-2650
Practice Address - Fax:314-771-0784
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014006318363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical