Healthcare Provider Details

I. General information

NPI: 1205084563
Provider Name (Legal Business Name): MELISSA ANN MOYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN STONG

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8515 EDNA AVE STE 240
LAS VEGAS NV
89117-4441
US

IV. Provider business mailing address

11035 LAVENDER HILL 160-587
LAS VEGAS NV
89135
US

V. Phone/Fax

Practice location:
  • Phone: 702-330-3490
  • Fax: 702-800-8450
Mailing address:
  • Phone: 702-330-3490
  • Fax: 702-800-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1108
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: