Healthcare Provider Details

I. General information

NPI: 1740117340
Provider Name (Legal Business Name): FAITH KRISTINA DEE MOSER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N TRAIL WAY
POOLER GA
31322-9816
US

IV. Provider business mailing address

101 N TRAIL WAY
POOLER GA
31322-9816
US

V. Phone/Fax

Practice location:
  • Phone: 239-222-2081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: