Jordan David Mosely, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6428 Issued in NC

Practice address

6060 Piedmont Row Dr S Ste 120
Charlotte, NC 28287-2801

Phone

(704) 552-0116

NPI assigned

May 25, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1396310900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6060 PIEDMONT ROW DR S STE 120",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282872801",
            "telephone_number": "704-552-0116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6060 PIEDMONT ROW DR S STE 120",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282872801",
            "telephone_number": "704-552-0116"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 N Freedom Blvd",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846011677",
            "country_code": "US",
            "telephone_number": "801-373-4760",
            "fax_number": "801-373-0639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSELY",
        "first_name": "JORDAN",
        "middle_name": "DAVID",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-25",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "6428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Constantine Michael Moschopoulos, DO
• Mackenzie Drew Moschopoulos, CRNA
• Ann Marie Moseff, RPH
• Kim Moseley, LCSW
• Sullivan Moseley, PHD
• Sara Ann Moseman, D.O.
• Diana Alice Moser-Burg, PHD, LPC
• Ashley Elizabeth Moser, LMFT
• Dakota Moser, MA, LMFTA
• Holly Moser

• Psychologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.