Provider Demographics
NPI:1922181932
Name:MOSBY, JUDY GAYLE (FNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:GAYLE
Last Name:MOSBY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-0366
Mailing Address - Country:US
Mailing Address - Phone:601-482-9224
Mailing Address - Fax:
Practice Address - Street 1:1001 14TH STREET
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39302-0000
Practice Address - Country:US
Practice Address - Phone:800-897-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR516821363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P59078Medicare UPIN