Individual
JESSICA KEELY MOSCHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
207 CARTER ST, BERRYVILLE, AR 72616-4303
(870) 423-6661
Mailing address
207 CARTER ST, BERRYVILLE, AR 72616-4303
(870) 423-6661
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2007025317
MO
363L00000X
Nurse Practitioner
Primary
A005277
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420045434
—
MO
01
—
PENDING
MEDICARE
AR
01
—
PENDING
MEDICARE
MO
05
—
PENDING
—
AR
Enumeration date
06/19/2017
Last updated
12/10/2021
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