Provider Demographics
NPI:1902565567
Name:MOSS, ASHLEY (CPO)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 E MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4831
Mailing Address - Country:US
Mailing Address - Phone:501-368-0868
Mailing Address - Fax:501-368-0003
Practice Address - Street 1:2930 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4831
Practice Address - Country:US
Practice Address - Phone:501-368-0868
Practice Address - Fax:501-368-0003
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR00279222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist