Basic Information
| Provider Information | |||||||||
| NPI: | 1851635619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSER | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | RAF LAKENHEATH 48 MDG/SGHC | ||||||||
| Address2: | UNIT 5115 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 094615115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142668602 | ||||||||
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| Practice Location | |||||||||
| Address1: | 77 NEALY AVENUE | ||||||||
| Address2: | 633D MEDICAL GROUP | ||||||||
| City: | JOINT BASE LANGLEY-EUSTIS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236652040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7577646840 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 0024170986 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.