Active NPI
Derek Moos, AGPCNP-BC
- Primary Care Nurse Practitioner
- Syracuse, UT
National Provider Identifier
1104658749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- 6586693-4405
- Practice address
- 2977 West
2600 South
Syracuse, UT 84075 - Phone
- (801) 682-6170
- NPI assigned
- Aug 14, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 6586693-4405 | UT | Primary |
Addresses
Primary practice location
2977 West
2600 South
Syracuse, UT 84075
Mailing address
2977 West
2600 South
Syracuse, UT 84075
Phone (801) 682-6170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6586693-4405 | UT | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1104658749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2977 WEST",
"address_2": "2600 SOUTH",
"city": "SYRACUSE",
"state": "UT",
"postal_code": "84075",
"telephone_number": "801-682-6170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2977 WEST",
"address_2": "2600 SOUTH",
"city": "SYRACUSE",
"state": "UT",
"postal_code": "84075",
"telephone_number": "801-682-6170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOOS",
"first_name": "DEREK",
"credential": "AGPCNP-BC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-08-14",
"last_updated": "2024-08-14",
"certification_date": "2024-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "UT",
"license": "6586693-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.