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General NPI Number Information
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NPI Number | 1912340449
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Entity Type | Individual
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Provider Name | TAMRA EDWANA MOSS APRN
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Gender | Female
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 197 WILL WALKER RD
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City | COLUMBIA
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State | KY
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Zip | 42728-7436
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Country | US
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Telephone | 270-384-9981
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Fax | 270-384-9989
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Provider Business Mailing Address
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Address Line | PO BOX 1080
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City | BURKESVILLE
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State | KY
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Zip | 42717-1080
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Country | US
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Telephone | 270-864-1472
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Fax | 270-864-1693
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007062
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License Number State | KY
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