MEDICARE: CARRIE MOSLEY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	557554	CA

General Provider Information

NPI Number	:	1336190933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE MOSLEY FNP-C

Provider Business Mailing Address
First Line	:	3838 SAN DIMAS ST
Second Line	:	STE 250
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-2284
Country	:	US
Telephone Number	:	661-321-3161
Fax Number	:	661-321-3166

Provider Business Practice Location Address
First Line	:	3838 SAN DIMAS ST
Second Line	:	STE 250
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-2284
Country	:	US
Telephone Number	:	661-323-5300
Fax Number	:	661-323-5455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/06/2016

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