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NPI Code Detail

MEDICARE: KELLY G MOSS MD

MEDICARE: KELLY G MOSS MD
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
1207Q00000XFamily Medicine Physician14487KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114936192
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY G MOSS MD
Provider Business Mailing Address
First Line : PO BOX 550
Second Line :
City : VANCEBURG
State : KY
Zip : 41179-0550
Country : US
Telephone Number : 606-796-3029
Fax Number : 606-796-6221
Provider Business Practice Location Address
First Line : 211 KY 59
Second Line :
City : VANCEBURG
State : KY
Zip : 41179-7647
Country : US
Telephone Number : 606-796-3029
Fax Number : 606-796-6221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2006
Last Update Date : 08/16/2012

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Directions to “ KELLY G MOSS MD” Practice Location

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