MEDICARE: MIKSHIRA MARIE MOSELY FNP

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	AP10142	LA
2	363LP2300X	Primary Care Nurse Practitioner	AP10142	LA

General Provider Information

NPI Number	:	1780160606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKSHIRA MARIE MOSELY FNP

Provider Business Mailing Address
First Line	:	5444 ELYSIAN FIELDS AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-4222
Country	:	US
Telephone Number	:	504-376-4017
Fax Number	:	504-226-0892

Provider Business Practice Location Address
First Line	:	141 ALLEN TOUSSAINT BLVD # 1083
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-2534
Country	:	US
Telephone Number	:	504-376-4017
Fax Number	:	504-226-0892

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

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	10/25/2025

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