Provider Demographics
NPI:1528654191
Name:MOSS, NELS CARLOS III (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:NELS
Middle Name:CARLOS
Last Name:MOSS
Suffix:III
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6069
Mailing Address - Country:US
Mailing Address - Phone:573-882-2121
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-6521
Practice Address - Country:US
Practice Address - Phone:573-882-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020023487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty