Provider Demographics
NPI:1265328173
Name:MOSS, ASHLEY KRISTINA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KRISTINA
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4982 PAULA 17.3 ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-9432
Mailing Address - Country:US
Mailing Address - Phone:818-826-3354
Mailing Address - Fax:
Practice Address - Street 1:4982 PAULA 17.3 ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-9432
Practice Address - Country:US
Practice Address - Phone:818-826-3354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA002859451376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide