MEDICARE: JESSICA LEE MOSS FNP, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	SP027082	PA

General Provider Information

NPI Number	:	1013618776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEE MOSS FNP, RN

Provider Business Mailing Address
First Line	:	PO BOX 104
Second Line	:
City	:	RENO
State	:	PA
Zip	:	16343-0104
Country	:	US
Telephone Number	:	814-516-3286
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 OAK ST
Second Line	:
City	:	RENO
State	:	PA
Zip	:	16343-1039
Country	:	US
Telephone Number	:	814-516-3286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	03/10/2023

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