Provider Demographics
NPI:1548492945
Name:MOSS, ERICA COURTNEY (APRN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:COURTNEY
Last Name:MOSS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 BELLEGRASS BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1904
Mailing Address - Country:US
Mailing Address - Phone:601-421-1588
Mailing Address - Fax:
Practice Address - Street 1:1201 HIGHWAY 49 S STE 1
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9438
Practice Address - Country:US
Practice Address - Phone:601-664-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03285363LF0000X
MS905177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199750758Medicaid
ARA003285OtherAPN LICENSE
AR100907002Medicaid
AR040072Medicare Oscar/Certification
AR043456Medicare Oscar/Certification
AR043480Medicare Oscar/Certification
ARA03285OtherAPN LICENSE
AR129734729Medicaid
AR129735729Medicaid
AR043492Medicare Oscar/Certification
AR136428729Medicaid