Basic Information
| Provider Information | |||||||||
| NPI: | 1144274069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSS | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | SNYDER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MOSS | ||||||||
| OtherFirstName: | REBECCA | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | DOGWOOD AVE | ||||||||
| Address2: | BUILDING 160 | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | DOGWOOD AVE | ||||||||
| Address2: | BUILDING 160 | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN0000005281 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 5281 | 01 | TN | ADVANCED PRACTICE NURSE | OTHER |