Provider Demographics
NPI:1932981040
Name:MOSS, JOY (NP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18420 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9235
Mailing Address - Country:US
Mailing Address - Phone:816-204-4951
Mailing Address - Fax:
Practice Address - Street 1:18420 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-9235
Practice Address - Country:US
Practice Address - Phone:816-204-4951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS81578363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner