Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 207187 | LA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 903433 | MS |
NPI | 1003468786 |
---|---|
Provider Name | Dawn Moss |
First Address | Natchez, MS 39120-4611 |
Second Address | Natchez, MS 39120-4611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 12/07/2019 |