MEDICARE: ROSLYN MOODLEY AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	18147	TN
2	363LA2200X	Adult Health Nurse Practitioner	18147	TN
3	363LG0600X	Gerontology Nurse Practitioner	18147	TN
4	363LA2200X	Adult Health Nurse Practitioner	AP134509	TX

General Provider Information

NPI Number	:	1386075125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSLYN MOODLEY AGACNP-BC

Provider Business Mailing Address
First Line	:	6550 FANNIN ST STE 1401
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2738
Country	:	US
Telephone Number	:	713-441-5141
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST STE 1601
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-441-5141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2013
Last Update Date	:	04/09/2026

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