Healthcare Provider Details

I. General information

NPI: 1346117660
Provider Name (Legal Business Name): STEPHANIE MOSLEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 6TH ST
PORTSMOUTH OH
45662-4030
US

IV. Provider business mailing address

1225 MAIN ST
WEST PORTSMOUTH OH
45663-5977
US

V. Phone/Fax

Practice location:
  • Phone: 740-876-8290
  • Fax: 740-529-1205
Mailing address:
  • Phone: 740-935-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.181591.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: