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General NPI Number Information
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NPI Number | 1487240214
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Entity Type | Individual
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Provider Name | STEPHANIE YVONNE MOSS
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Gender | Female
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 8011 CLAYTON RD STE 216
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1156
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Country | US
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Telephone | 314-260-7440
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Fax | 314-260-1196
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Provider Business Mailing Address
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Address Line | 1600 N 2ND ST APT C
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2294
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Country | US
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Telephone | 636-578-9223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 5379763052
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License Number State | KS
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