Provider Demographics
NPI:1255074209
Name:MOSELEY, KAITLYN MERLOT (MD)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:MERLOT
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 S COULTER ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1786
Mailing Address - Country:US
Mailing Address - Phone:806-414-9559
Mailing Address - Fax:806-351-3765
Practice Address - Street 1:1400 S COULTER ST STE 1500
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9559
Practice Address - Fax:806-351-3765
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU9036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine