Healthcare Provider Details

I. General information

NPI: 1750146320
Provider Name (Legal Business Name): COREY BLAKE MOSLEY APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 S LAKE DR
PRESTONSBURG KY
41653-1340
US

IV. Provider business mailing address

723 S LAKE DR
PRESTONSBURG KY
41653-1340
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-8175
  • Fax: 606-430-7014
Mailing address:
  • Phone: 606-886-8175
  • Fax: 606-430-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4016205
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: