MEDICARE: LESLIE S. MOSS CNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CP001302	SD

General Provider Information

NPI Number	:	1700398492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE S. MOSS CNP

Provider Business Mailing Address
First Line	:	520 KANSAS CITY ST STE 102
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2766
Country	:	US
Telephone Number	:	605-716-3609
Fax Number	:	605-716-3707

Provider Business Practice Location Address
First Line	:	520 KANSAS CITY ST STE 102
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2766
Country	:	US
Telephone Number	:	605-716-3609
Fax Number	:	605-716-3707

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

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	02/21/2026

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