Provider Demographics
NPI:1174603864
Name:MOSS, RITA JENKINS (NP)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:JENKINS
Last Name:MOSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:JENKINS
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:55 BUCKEYE COVE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-4511
Mailing Address - Country:US
Mailing Address - Phone:828-648-0282
Mailing Address - Fax:828-648-3479
Practice Address - Street 1:55 BUCKEYE COVE RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-4511
Practice Address - Country:US
Practice Address - Phone:828-648-0282
Practice Address - Fax:828-648-3479
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201666363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003980Medicaid
NC173PUOtherBCBS
NC173PUOtherBCBS
NC7003980Medicaid