Active NPI
Derek Moss, BSN, RN
- Registered Nurse
- Park City, UT
National Provider Identifier
1174201644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4828635-3102
- Practice address
- 650 Round Valley Dr
Park City, UT 84060-7571 - Phone
- (435) 333-1504
- NPI assigned
- Jul 6, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 4828635-3102 | UT | |
| Registered Nurse | 163W00000X | 4828635-3102 | UT | Primary |
Addresses
Primary practice location
650 Round Valley Dr
Park City, UT 84060-7571
Mailing address
650 Round Valley Dr
Park City, UT 84060-7571
Phone (435) 333-1504
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
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4828635-3102 | UT | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688601600000",
"number": "1174201644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 ROUND VALLEY DR",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840607571",
"telephone_number": "435-333-1504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 ROUND VALLEY DR",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840607571",
"telephone_number": "435-333-1504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "DEREK",
"credential": "BSN, RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-06",
"last_updated": "2023-07-06",
"certification_date": "2023-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "UT",
"license": "4828635-3102",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "UT",
"license": "4828635-3102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.