Provider Demographics
NPI:1366456592
Name:MOSLEY, DARCY MATTHEWS I (PA)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:MATTHEWS
Last Name:MOSLEY
Suffix:I
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8903
Mailing Address - Country:US
Mailing Address - Phone:205-221-5374
Mailing Address - Fax:205-385-0382
Practice Address - Street 1:2950 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8903
Practice Address - Country:US
Practice Address - Phone:205-221-5374
Practice Address - Fax:205-385-0382
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934567Medicaid
AL515-31074OtherBCBS PROVIDER NUMBER
ALQ53176Medicare UPIN