Healthcare Provider Details

I. General information

NPI: 1063323061
Provider Name (Legal Business Name): CASI MOSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 E 79TH ST
TULSA OK
74133-4564
US

IV. Provider business mailing address

10109 E 79TH ST
TULSA OK
74133-4564
US

V. Phone/Fax

Practice location:
  • Phone: 918-233-9550
  • Fax:
Mailing address:
  • Phone: 918-233-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number213027
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: