Provider Demographics
NPI:1174751895
Name:MOSLEY, KIM (CNA)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85636-0083
Mailing Address - Country:US
Mailing Address - Phone:520-678-9851
Mailing Address - Fax:
Practice Address - Street 1:727 HEATHER DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-3033
Practice Address - Country:US
Practice Address - Phone:520-678-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health