MEDICARE: HEATHER LYNN MOSSBARGER PA-C

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	363A00000X	Physician Assistant	2203	WV
2	363AM0700X	Medical Physician Assistant	50.005786RX	OH
3	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1194206128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LYNN MOSSBARGER PA-C

Provider Business Mailing Address
First Line	:	2781 CORA MILL RD
Second Line	:
City	:	GALLIPOLIS
State	:	OH
Zip	:	45631-8539
Country	:	US
Telephone Number	:	740-516-3273
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 GRAND CENTRAL AVE STE 3
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-2150
Country	:	US
Telephone Number	:	304-865-0555
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	12/26/2023

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