Provider Demographics
NPI:1922468370
Name:MOSIER, CARYN MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:MICHELLE
Last Name:MOSIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARYN
Other - Middle Name:MOSIER
Other - Last Name:MCANARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1509 NARANJO DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4007
Mailing Address - Country:US
Mailing Address - Phone:956-245-6138
Mailing Address - Fax:
Practice Address - Street 1:1509 NARANJO DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4007
Practice Address - Country:US
Practice Address - Phone:956-245-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-28
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP10785363A00000X
TXPA10785363A00000X, 363AM0700X
TXPA010785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical