Provider Demographics
NPI:1659430114
Name:MOSLEY, LEAH J (PA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:J
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:J
Other - Last Name:SCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1329
Mailing Address - Country:US
Mailing Address - Phone:573-339-1957
Mailing Address - Fax:573-339-9709
Practice Address - Street 1:1723 BROADWAY ST
Practice Address - Street 2:SUITE 410
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4566
Practice Address - Country:US
Practice Address - Phone:573-339-1957
Practice Address - Fax:573-339-9709
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant