Healthcare Provider Details

I. General information

NPI: 1962867127
Provider Name (Legal Business Name): JESSICA MOSLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N WASHINGTON ST
LIVINGSTON AL
35470-5410
US

IV. Provider business mailing address

PO BOX 5392
MERIDIAN MS
39302-5392
US

V. Phone/Fax

Practice location:
  • Phone: 205-652-9575
  • Fax: 205-652-7979
Mailing address:
  • Phone: 601-213-3010
  • Fax: 601-213-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-132217
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-132217
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: