Healthcare Provider Details

I. General information

NPI: 1700398492
Provider Name (Legal Business Name): LESLIE S. MOSS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 KANSAS CITY ST STE 102
RAPID CITY SD
57701-2766
US

IV. Provider business mailing address

520 KANSAS CITY ST STE 102
RAPID CITY SD
57701-2766
US

V. Phone/Fax

Practice location:
  • Phone: 605-716-3609
  • Fax: 605-716-3707
Mailing address:
  • Phone: 605-716-3609
  • Fax: 605-716-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP001302
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: