MEDICARE: PROMISE KEPT PSYCHIATRIC AND CONSULTATION SERVICES, LLC

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
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1861336638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMISE KEPT PSYCHIATRIC AND CONSULTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	165 DAY DR
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-6721
Country	:	US
Telephone Number	:	229-586-6504
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 DAY DR
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-6721
Country	:	US
Telephone Number	:	229-586-6504
Fax Number	:	229-297-8292

Authorized Official
Title or Position	:	DNP PMHNP FNP
Name	:	MRS. VASHAWN RENEE MOSLEY
Credential	:	NP
Telephone Number	:	229-205-9287

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	06/01/2026

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