Provider Demographics
NPI:1689602179
Name:MOSELEY-LARUE, RAJEAN RACHEL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RAJEAN
Middle Name:RACHEL
Last Name:MOSELEY-LARUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:RAJEAN
Other - Middle Name:RACHEL
Other - Last Name:MOSELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6497 GRANBURY HWY
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-5702
Mailing Address - Country:US
Mailing Address - Phone:817-917-0631
Mailing Address - Fax:817-599-8106
Practice Address - Street 1:6503 GRANBURY HWY
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76087-6003
Practice Address - Country:US
Practice Address - Phone:817-917-0631
Practice Address - Fax:817-259-1259
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01480363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83N224Medicare PIN
TX8L13641Medicare PIN