Provider Demographics
NPI:1457787509
Name:MOSS, SERENA NICHOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:NICHOLE
Last Name:MOSS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CHATEAU DR SW STE 302
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7413
Mailing Address - Country:US
Mailing Address - Phone:256-855-1605
Mailing Address - Fax:256-855-1905
Practice Address - Street 1:185 CHATEAU DR SW STE 302
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7413
Practice Address - Country:US
Practice Address - Phone:256-885-1605
Practice Address - Fax:256-885-1905
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230692363L00000X
AL1-118810363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner