Provider Demographics
NPI:1457767881
Name:MOSS, ANGELA CHARLENE (RN,BSN,QMHP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHARLENE
Last Name:MOSS
Suffix:
Gender:F
Credentials:RN,BSN,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 CAMPBELL CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:MEHERRIN
Mailing Address - State:VA
Mailing Address - Zip Code:23954
Mailing Address - Country:US
Mailing Address - Phone:434-390-7166
Mailing Address - Fax:
Practice Address - Street 1:231 HICKORY RD
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944-3503
Practice Address - Country:US
Practice Address - Phone:434-676-1378
Practice Address - Fax:434-676-1391
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001139794163WA0400X, 163WP0807X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult