Individual
KENYA D MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
4321 FIR ST, EAST CHICAGO, IN 46312-3049
(219) 392-7446
(219) 392-7470
Mailing address
16700 LUELLA AVE, SOUTH HOLLAND, IL 60473-2619
(708) 715-7320
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
28201922A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71014366A
IN
Other
Enumeration date
08/25/2023
Last updated
09/25/2023
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