Provider Demographics
NPI:1902504996
Name:MOSELEY, LUCIAN CLEMENT (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LUCIAN
Middle Name:CLEMENT
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E PEACOCK ST STE A
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-7847
Mailing Address - Country:US
Mailing Address - Phone:478-271-3200
Mailing Address - Fax:
Practice Address - Street 1:150 E PEACOCK ST STE A
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-7847
Practice Address - Country:US
Practice Address - Phone:478-271-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278741363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse