Provider Demographics
NPI:1811256431
Name:MOSES, EDNA (APRN)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:MOSES
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 1:686 S HIGHWAY 25 W
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1604
Mailing Address - Country:US
Mailing Address - Phone:606-549-5052
Mailing Address - Fax:606-549-2718
Practice Address - Street 1:686 S HIGHWAY 25 W
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1604
Practice Address - Country:US
Practice Address - Phone:606-549-5052
Practice Address - Fax:606-549-2718
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100209220Medicaid