Provider Demographics
NPI:1104876929
Name:MOSS, KYSHONE CHAYONNE (RN)
Entity type:Individual
Prefix:MRS
First Name:KYSHONE
Middle Name:CHAYONNE
Last Name:MOSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52810 SANDIA DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1074
Mailing Address - Country:US
Mailing Address - Phone:254-200-2339
Mailing Address - Fax:254-200-2339
Practice Address - Street 1:36000 DARNALL LOOP DARNALL ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8639
Practice Address - Fax:254-288-8970
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX711455163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care