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General NPI Number Information
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NPI Number | 1497452205
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Entity Type | Individual
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Provider Name | KATRINA MOSS APRN, AGACNP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1650 W COLLEGE ST
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City | GRAPEVINE
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State | TX
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Zip | 76051-3565
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Country | US
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Telephone | 817-329-2598
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Fax |
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Provider Business Mailing Address
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Address Line | 505 S NOLEN DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9167
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Country | US
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Telephone |
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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 | 1100629
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License Number State | TX
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