MEDICARE: MRS. KALEE MOSES PA-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	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568051688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KALEE MOSES PA-C

Provider Business Mailing Address
First Line	:	10924 BLOOMINGDALE AVE
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-3633
Country	:	US
Telephone Number	:	813-571-1111
Fax Number	:	813-571-1120

Provider Business Practice Location Address
First Line	:	10924 BLOOMINGDALE AVE
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-3633
Country	:	US
Telephone Number	:	813-571-1111
Fax Number	:	813-571-1120

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

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	02/06/2026

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