Kelsey-Jo Audrey Moss, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

201907307NP-PP Issued in OR

Practice address

704B NE 62ND Ave
Portland, OR 97213-4351

Phone

(971) 400-7350

NPI assigned

Oct 30, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelsey-Jo Audrey Hodges Former name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hillsboro Pediatric Clinic LLC

  • Pediatrics Physician
  • Hillsboro, OR
  • NPI 1245312842
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572393600000",
    "number": "1477197705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704B NE 62ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972134351",
            "telephone_number": "971-400-7350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704B NE 62ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972134351",
            "telephone_number": "971-400-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "KELSEY-JO",
        "middle_name": "AUDREY",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-30",
        "last_updated": "2019-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OR",
            "license": "201907307NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY-JO",
            "last_name": "HODGES",
            "middle_name": "AUDREY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Audrey Rock Moss, L.AC., LMT
• Benjamin Moss, MD
• Jacob Russell Moss
• Jennifer Melissa Moss, MFT
• Josha Moss, PTA
• Lenore Marie Moss
• Lori Noel Moss, RN, BSN, CCRN
• Lynnsey Kay Moss, MD
• Michael J Moss, MD
• Sophia Moss

• Pediatric Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Pediatric Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.