Provider Demographics
NPI:1124723812
Name:MOSELY, TASHAUNA (LPN)
Entity type:Individual
Prefix:
First Name:TASHAUNA
Middle Name:
Last Name:MOSELY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 KATY FWY APT 557
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-5139
Mailing Address - Country:US
Mailing Address - Phone:863-244-7359
Mailing Address - Fax:
Practice Address - Street 1:10300 KATY FWY APT 557
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-5139
Practice Address - Country:US
Practice Address - Phone:713-530-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPN52190164W00000X
FLPN5219048164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse