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NPI Code Detail

MEDICARE: CORY VASTINA MOODY RICE AGNP-C

MEDICARE: CORY VASTINA MOODY RICE AGNP-C
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
1363LF0000XFamily Nurse Practitioner1221555TX

General Provider Information

NPI Number : 1184569188
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY VASTINA MOODY RICE AGNP-C
Provider Business Mailing Address
First Line : 2537 GOLDEN BEAR DR
Second Line :
City : CARROLLTON
State : TX
Zip : 75006-2377
Country : US
Telephone Number : 318-268-8278
Fax Number :
Provider Business Practice Location Address
First Line : 2537 GOLDEN BEAR DR
Second Line :
City : CARROLLTON
State : TX
Zip : 75006-2377
Country : US
Telephone Number : 318-268-8278
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2026
Last Update Date : 04/23/2026

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