Basic Information
| Provider Information | |||||||||
| NPI: | 1487150124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSLEY | ||||||||
| FirstName: | PATRICE | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9385 E WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462293029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178994731 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5515 W 38TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462542995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178803838 | ||||||||
| FaxNumber: | 3178800081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2018 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 28190080A | IN | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363L00000X | 71008298A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.