Healthcare Provider Details

I. General information

NPI: 1225452873
Provider Name (Legal Business Name): REBECCA C MOSS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

IV. Provider business mailing address

3126 S JACKSON AVE STE 101
JOPLIN MO
64804-2534
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-4000
  • Fax:
Mailing address:
  • Phone: 417-781-0408
  • Fax: 417-627-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0033437
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014002628
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11634
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: