Provider Demographics
NPI:1215233242
Name:MOSLEY, JACQUELINE C (NP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:C
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 W RANDOL MILL RD STE 2300
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2504
Mailing Address - Country:US
Mailing Address - Phone:817-960-6648
Mailing Address - Fax:817-960-6649
Practice Address - Street 1:800 W RANDOL MILL RD STE 2300
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-960-6648
Practice Address - Fax:817-960-6649
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119999363LA2100X
GARN303631363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care