Provider Demographics
NPI:1366523961
Name:MOES, CAROLYN BARKLEY (CNM, MSN)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:BARKLEY
Last Name:MOES
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 LANDERBROOK DR
Mailing Address - Street 2:SUIITE 300
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6531
Mailing Address - Country:US
Mailing Address - Phone:440-995-3805
Mailing Address - Fax:440-995-3806
Practice Address - Street 1:5850 LANDERBROOK DR
Practice Address - Street 2:SUIITE 300
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-6531
Practice Address - Country:US
Practice Address - Phone:440-995-3805
Practice Address - Fax:440-995-3806
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM03434367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0525702Medicaid
OH0525702Medicaid