Basic Information
Provider Information
NPI: 1205801289
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOSS
FirstName: ELISHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: P.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 15268
Address2:  
City: ASHEVILLE
State: NC
PostalCode: 288130268
CountryCode: US
TelephoneNumber: 8282502833
FaxNumber: 8286658275
Practice Location
Address1: 509 BILTMORE AVENUE
Address2:  
City: ASHEVILLE
State: NC
PostalCode: 28801
CountryCode: US
TelephoneNumber: 8282131995
FaxNumber: 8282131992
Other Information
ProviderEnumerationDate: 02/22/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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