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NPI Code Detail

MEDICARE: DR. PAMELA KAY MOODY PHD, DNP, APRN-BC

MEDICARE: DR. PAMELA KAY MOODY PHD, DNP, APRN-BC
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 Practitioner1-033023AL

General Provider Information

NPI Number : 1184606360
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAMELA KAY MOODY PHD, DNP, APRN-BC
Provider Business Mailing Address
First Line : 11589 COUNCIL BARBER BLVD
Second Line :
City : NORTHPORT
State : AL
Zip : 35475-5501
Country : US
Telephone Number : 205-799-9108
Fax Number :
Provider Business Practice Location Address
First Line : 2350 HARGROVE RD E
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35405-2612
Country : US
Telephone Number : 205-554-4546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 09/24/2010

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