=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013801356
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLY MOSELEY PETERSON NBC-HWC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2025
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13860 ST STEPHENS AVE
-----------------------------------------------------
City | CHATOM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-600-9119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 445 OR 13860 ST. STEPHENS AVE.
-----------------------------------------------------
City | CHATOM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-600-9119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------