Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1018708 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | 1018708 | TX |
NPI | 1063082709 |
---|---|
Provider Name | Kelsey Nicole Moczulski |
First Address | Houston, TX 77005-1821 |
Second Address | Houston, TX 77005-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2021 |
Last Update Date | 25/06/2021 |