Provider Demographics
NPI:1205440419
Name:MOSLEY, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
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:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-0531
Mailing Address - Country:US
Mailing Address - Phone:681-220-3592
Mailing Address - Fax:
Practice Address - Street 1:25 76TH STREET
Practice Address - Street 2:
Practice Address - City:KOPPERSTON
Practice Address - State:WV
Practice Address - Zip Code:24854
Practice Address - Country:US
Practice Address - Phone:681-220-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant