# ROCKSAN MOSS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1225098510
- **Gender:** F
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 004380 | GA | Yes |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 05/19/2021

## 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 |