Provider Demographics
NPI:1396420576
Name:MOSLEY, LISA RENEE (CPSS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6046 S US HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-4947
Mailing Address - Country:US
Mailing Address - Phone:606-514-5031
Mailing Address - Fax:
Practice Address - Street 1:2542 W LAUREL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8375
Practice Address - Country:US
Practice Address - Phone:606-514-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist