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Individual
ROCKSAN MOSS
Active
Individual
ROCKSAN MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004380
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10059174
AMERIGROUP
GA
05
—
638560621A
—
GA
05
—
638560621C
—
GA
05
—
638560621D
—
GA
05
—
638560621E
—
GA
01
—
9603746-1206
STATE LICENSE
UT
Enumeration date
03/23/2006
Last updated
05/19/2021
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