Provider Demographics
NPI:1811302029
Name:PETERSON MOSS, RACHEL LEE (NP-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEE
Last Name:PETERSON MOSS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S HOUSTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6308
Mailing Address - Country:US
Mailing Address - Phone:478-666-3377
Mailing Address - Fax:478-333-1259
Practice Address - Street 1:530 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6308
Practice Address - Country:US
Practice Address - Phone:478-666-3377
Practice Address - Fax:478-333-1259
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner