MEDICARE: MRS. KATHLEEN M MOSER 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	APN1369	SC

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	:	1841265824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN M MOSER FNP

Provider Business Mailing Address
First Line	:	1228 HARDEN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-1800
Country	:	US
Telephone Number	:	803-733-5969
Fax Number	:	803-748-9953

Provider Business Practice Location Address
First Line	:	1228 HARDEN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-1800
Country	:	US
Telephone Number	:	803-733-5969
Fax Number	:	803-748-9953

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/02/2012

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