Healthcare Provider Details

I. General information

NPI: 1396223749
Provider Name (Legal Business Name): ABBY MOODY MILLER DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2018
Last Update Date: 08/18/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67252 INDUSTRY LN
COVINGTON LA
70433-8704
US

IV. Provider business mailing address

65484 MULBERRY ST
MANDEVILLE LA
70448-8418
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-9888
  • Fax:
Mailing address:
  • Phone: 225-939-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP10170
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: