Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1058998 | TX |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 70213 | ID |
NPI | 1013675883 |
---|---|
Provider Name | Salome Mosses |
First Address | Plano, TX 75026-2351 |
Second Address | Dallas, TX 75390-7201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2021 |
Last Update Date | 29/11/2021 |