Individual
MRS. JACLYN IRIS MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP B-C
Contact information
Practice address
5482 FIESTA DR, MEMPHIS, TN 38120-2827
(901) 831-1358
Mailing address
5482 FIESTA DR, MEMPHIS, TN 38120-2827
(901) 831-1358
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
14186
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04680711
—
MS
05
—
1524904
—
TN
Enumeration date
12/09/2009
Last updated
03/21/2024
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