Healthcare Provider Details

I. General information

NPI: 1255074209
Provider Name (Legal Business Name): KAITLYN MERLOT MOSELEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WALLACE BLVD
AMARILLO TX
79106-1789
US

IV. Provider business mailing address

1600 WALLACE BLVD
AMARILLO TX
79106-1799
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-2000
  • Fax:
Mailing address:
  • Phone: 806-212-1135
  • Fax: 806-212-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU9036
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: