Provider Demographics
NPI:1396307385
Name:MOSS, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64724-1474
Mailing Address - Country:US
Mailing Address - Phone:816-888-9110
Mailing Address - Fax:
Practice Address - Street 1:805 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-9382
Practice Address - Country:US
Practice Address - Phone:660-200-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse