# JOSH CHARLES MOULIN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1053503458
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282NR1301X | Rural Acute Care Hospital | T01460 | KS | — |
| 363A00000X | Physician Assistant | 15-01214 | KS | Yes |
| 363A00000X | Physician Assistant | 1501214 | KS | — |

## Other

- **Enumeration date:** 08/10/2007
- **Last updated:** 07/30/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 30004521840001 | — | KS |
| 01 | — | 427174 | MEDICARE ID UNSPECIFIED | KS |