Healthcare Provider Details

I. General information

NPI: 1700528486
Provider Name (Legal Business Name): DESHONNA MOSLEY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 MAIN ST STE A
PHILADELPHIA MS
39350-2562
US

IV. Provider business mailing address

532 MAIN ST STE A
PHILADELPHIA MS
39350-2562
US

V. Phone/Fax

Practice location:
  • Phone: 769-236-9500
  • Fax: 601-676-0550
Mailing address:
  • Phone: 769-236-9500
  • Fax: 601-676-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number883787
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: