MEDICARE: MS. ERICA COURTNEY MOSS APRN, FNP-BC

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	363LF0000X	Family Nurse Practitioner	A03285	AR
2	363LF0000X	Family Nurse Practitioner	905177	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A003285	OTHER	AR	APN LICENSE

General Provider Information

NPI Number	:	1548492945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA COURTNEY MOSS APRN, FNP-BC

Provider Business Mailing Address
First Line	:	92 BELLEGRASS BLVD
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1904
Country	:	US
Telephone Number	:	601-421-1588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 HIGHWAY 49 S STE 1
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-9438
Country	:	US
Telephone Number	:	601-664-0055
Fax Number	:

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

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	11/27/2023

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