Individual
MR. ENOS KENNETH MOSS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, MSN, ANP-BC
Contact information
Practice address
14101 SULLYFIELD CIR STE 400A, CHANTILLY, VA 20151-1781
(888) 478-1882
Mailing address
12125 CONWAY ROAD, SUITE 160, SAINT LOUIS, MO 63141
(314) 251-2870
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
2012011952
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2012011952
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548527997
—
MO
Enumeration date
04/23/2012
Last updated
03/17/2018
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