Provider Demographics
NPI:1861750226
Name:MOSLEY, HOLLY DENISE
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:DENISE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 THOMAS DR
Mailing Address - Street 2:APT 711
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2183
Mailing Address - Country:US
Mailing Address - Phone:405-501-5381
Mailing Address - Fax:
Practice Address - Street 1:2500 THOMAS DR
Practice Address - Street 2:APT 711
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2183
Practice Address - Country:US
Practice Address - Phone:405-501-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1861750226Medicaid