Healthcare Provider Details

I. General information

NPI: 1982368320
Provider Name (Legal Business Name): JULIA MOSES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 CUMBERLAND FALLS HWY STE B
CORBIN KY
40701-2720
US

IV. Provider business mailing address

1317 CUMBERLAND FALLS HWY STE B
CORBIN KY
40701-2720
US

V. Phone/Fax

Practice location:
  • Phone: 606-620-4153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016874
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: