Provider Demographics
NPI:1033655394
Name:MOSBY-PETERSON, DORIS MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:MARIE
Last Name:MOSBY-PETERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:MARIE
Other - Last Name:MOSBY-PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:5200 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-3048
Mailing Address - Country:US
Mailing Address - Phone:816-665-6124
Mailing Address - Fax:
Practice Address - Street 1:5200 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-3048
Practice Address - Country:US
Practice Address - Phone:816-665-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201701363LF0000X
GAGAA-NP000268363LF0000X
KS53-77041-011363LF0000X
MO2017000664363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care