Provider Demographics
NPI:1982218053
Name:MOSLEY, ERICA ANNETTE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANNETTE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4140
Mailing Address - Country:US
Mailing Address - Phone:601-703-1481
Mailing Address - Fax:
Practice Address - Street 1:1702 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4140
Practice Address - Country:US
Practice Address - Phone:601-703-1481
Practice Address - Fax:601-703-1484
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily