MEDICARE: MOONLIT MENTAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1114863081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONLIT MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2249 W WASHINGTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-6703
Country	:	US
Telephone Number	:	903-471-7546
Fax Number	:

Provider Business Practice Location Address
First Line	:	2249 W WASHINGTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-6703
Country	:	US
Telephone Number	:	918-280-9679
Fax Number	:	949-988-2941

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	MRS. SARAH ABIGAIL WOODY
Credential	:	PMHNP-BC
Telephone Number	:	918-280-9679

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	05/18/2026

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