Healthcare Provider Details

I. General information

NPI: 1962464883
Provider Name (Legal Business Name): REBEKAH ABIGAIL MOSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N 2ND ST
BOONEVILLE MS
38829-1028
US

IV. Provider business mailing address

1301 N 2ND ST
BOONEVILLE MS
38829-1028
US

V. Phone/Fax

Practice location:
  • Phone: 662-728-2071
  • Fax: 662-728-2077
Mailing address:
  • Phone: 662-728-2071
  • Fax: 662-728-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number858253
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: