Provider Demographics
NPI:1447049804
Name:EVANS MOSS, KAREN R
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:EVANS MOSS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SOPWITH WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-6311
Mailing Address - Country:US
Mailing Address - Phone:304-268-9896
Mailing Address - Fax:304-268-9896
Practice Address - Street 1:57 SOPWITH WAY
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-6311
Practice Address - Country:US
Practice Address - Phone:304-268-9896
Practice Address - Fax:304-268-9896
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst