Provider Demographics
NPI:1508064338
Name:MOSBEY, MARY ANN (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MOSBEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:SAGRAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:104 S FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1614
Mailing Address - Country:US
Mailing Address - Phone:606-886-8572
Mailing Address - Fax:606-886-4433
Practice Address - Street 1:104 S FRONT AVE
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-886-8572
Practice Address - Fax:606-886-4433
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1096923163W00000X
OHNP-11374363LF0000X
KY3005236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY71000029140Medicaid
WV3810016830Medicaid
OH3027567Medicaid
WV3810016830Medicaid