Provider Demographics
NPI:1134784135
Name:MOSLEY, KIRSTIN USIE
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:USIE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 HEALTH CARE DR.
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037
Mailing Address - Country:US
Mailing Address - Phone:318-706-0022
Mailing Address - Fax:318-706-0023
Practice Address - Street 1:170 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037
Practice Address - Country:US
Practice Address - Phone:318-706-0022
Practice Address - Fax:318-706-0023
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA331287208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics