Individual
KELSEY-JO AUDREY MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
704B NE 62ND AVE, PORTLAND, OR 97213-4351
(971) 400-7350
Mailing address
704B NE 62ND AVE, PORTLAND, OR 97213-4351
(971) 400-7350
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
201907307NP-PP
OR
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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