Mr Enos Kenneth Moss Jr, RN, MSN, ANP-BC | |
14101 Sullyfield Cir Ste 400a, Chantilly, VA 20151-1781 | |
(888) 478-1882 | |
Not Available |
Full Name | Mr Enos Kenneth Moss Jr |
---|---|
Gender | Male |
Speciality | Nurse Practitioner |
Experience | 12 Years |
Location | 14101 Sullyfield Cir Ste 400a, Chantilly, Virginia |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1548527997 | NPI | - | NPPES |
1548527997 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LA2200X | Nurse Practitioner - Adult Health | 2012011952 (Missouri) | Secondary |
363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 2012011952 (Missouri) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Psychological And Behavioral Consultants Llc | 0446243760 | 335 |
Entity Name | Mercy Clinic Child And Adolescent Psychiatry Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1265562300 PECOS PAC ID: 7113981721 Enrollment ID: O20041115000078 |
Entity Name | Psychological & Behavioral Consultants Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1811915713 PECOS PAC ID: 0446243760 Enrollment ID: O20181204002777 |
Mailing Address | Practice Location Address |
---|---|
Mr Enos Kenneth Moss Jr, RN, MSN, ANP-BC 12125 Conway Road, Suite 160, Saint Louis, MO 63141 Ph: (314) 251-2870 | Mr Enos Kenneth Moss Jr, RN, MSN, ANP-BC 14101 Sullyfield Cir Ste 400a, Chantilly, VA 20151-1781 Ph: (888) 478-1882 |
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