Provider Demographics
NPI:1568051688
Name:MOSES, KALEE RAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KALEE
Middle Name:RAE
Last Name:MOSES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 MANATEE AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8624
Mailing Address - Country:US
Mailing Address - Phone:941-748-3065
Mailing Address - Fax:
Practice Address - Street 1:701 MANATEE AVE W STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8624
Practice Address - Country:US
Practice Address - Phone:863-990-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant