Healthcare Provider Details

I. General information

NPI: 1225597008
Provider Name (Legal Business Name): KERRY LEE MOSEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 LONGLEY LN
RENO NV
89511-2632
US

IV. Provider business mailing address

6500 LONGLEY LN
RENO NV
89511-2632
US

V. Phone/Fax

Practice location:
  • Phone: 775-799-7320
  • Fax:
Mailing address:
  • Phone: 775-352-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30217
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: