Provider Demographics
NPI:1083649495
Name:MOSLEY, KIMBERLY (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6907 CATALPA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-2393
Mailing Address - Country:US
Mailing Address - Phone:502-432-6586
Mailing Address - Fax:844-274-2148
Practice Address - Street 1:1941 BISHOP LN STE 506
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1969
Practice Address - Country:US
Practice Address - Phone:502-459-0220
Practice Address - Fax:844-274-2148
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004320363LA2200X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7801785200Medicaid
IN200824210AMedicaid
KYK046940Medicare PIN
Q66620Medicare UPIN
KYP00693367Medicare PIN