Provider Demographics
NPI:1073101911
Name:MOSLEY, JEKEISSA
Entity Type:Individual
Prefix:
First Name:JEKEISSA
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 BEDAZZLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-4709
Mailing Address - Country:US
Mailing Address - Phone:702-338-0615
Mailing Address - Fax:
Practice Address - Street 1:8879 W FLAMINGO RD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8732
Practice Address - Country:US
Practice Address - Phone:702-701-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant