Healthcare Provider Details

I. General information

NPI: 1194648147
Provider Name (Legal Business Name): ABIGAIL LYNN MOSS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 NW SAMARITAN DR STE 101
CORVALLIS OR
97330-4744
US

IV. Provider business mailing address

3521 NW SAMARITAN DR STE 101
CORVALLIS OR
97330-4744
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-6119
  • Fax:
Mailing address:
  • Phone: 541-768-6119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA230711
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: