MEDICARE: MS. RAJEAN RACHEL MOSELEY-LARUE 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	363AM0700X	Medical Physician Assistant	PA01480	TX

General Provider Information

NPI Number	:	1689602179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RAJEAN RACHEL MOSELEY-LARUE PA-C

Provider Business Mailing Address
First Line	:	6497 GRANBURY HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-5702
Country	:	US
Telephone Number	:	817-917-0631
Fax Number	:	817-599-8106

Provider Business Practice Location Address
First Line	:	6503 GRANBURY HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-6003
Country	:	US
Telephone Number	:	817-917-0631
Fax Number	:	817-259-1259

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	06/01/2023

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