Provider Demographics
NPI:1073338901
Name:MOSELY, WENDY (FNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MOSELY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W AIRPORT FWY STE 209
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6209
Mailing Address - Country:US
Mailing Address - Phone:214-777-2703
Mailing Address - Fax:
Practice Address - Street 1:1221 W AIRPORT FWY STE 209
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6209
Practice Address - Country:US
Practice Address - Phone:214-777-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily