Basic Information
| Provider Information | |||||||||
| NPI: | 1215233242 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSLEY | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 W RANDOL MILL RD STE 2300 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760122504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179606648 | ||||||||
| FaxNumber: | 8179606649 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W RANDOL MILL RD STE 2300 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760122504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179606648 | ||||||||
| FaxNumber: | 8179606649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | AP119999 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | RN303631 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.