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NPI Code Detail

MEDICARE: KELLY MOODY RN

MEDICARE: KELLY MOODY RN
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
1163WS0200XSchool Registered NurseL1-0029187DE

General Provider Information

NPI Number : 1730808759
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MOODY RN
Provider Business Mailing Address
First Line : 1235 CEDAR LANE RD
Second Line :
City : MIDDLETOWN
State : DE
Zip : 19709-9636
Country : US
Telephone Number : 302-449-3499
Fax Number :
Provider Business Practice Location Address
First Line : 1235 CEDAR LANE RD
Second Line :
City : MIDDLETOWN
State : DE
Zip : 19709-9636
Country : US
Telephone Number : 302-449-3499
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2022
Last Update Date : 08/23/2022

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