Healthcare Provider Details

I. General information

NPI: 1083132369
Provider Name (Legal Business Name): COURTNEY LYNN MOSLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/13/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 NATIONWIDE DR
LYNCHBURG VA
24502-4271
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE ATTN: MCHJ-CLQ-C
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 434-239-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number0001259170
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number60769375
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024188104
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: