Healthcare Provider Details

I. General information

NPI: 1760183032
Provider Name (Legal Business Name): SOPHIA GRACE MOODY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SEAGLE ST STE 10
HUNTERSVILLE NC
28078-4337
US

IV. Provider business mailing address

320 SEAGLE ST STE 10
HUNTERSVILLE NC
28078-4337
US

V. Phone/Fax

Practice location:
  • Phone: 704-368-4351
  • Fax: 704-519-2586
Mailing address:
  • Phone: 704-368-4351
  • Fax: 704-519-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5017823
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: