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General NPI Number Information
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NPI Number | 1073746343
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Entity Type | Individual
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Provider Name | NICOLE D MOODY NP
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Gender | Female
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 822 E AVENUE K
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City | LANCASTER
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State | CA
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Zip | 93535-4766
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Country | US
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Telephone | 661-579-9760
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Fax |
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Provider Business Mailing Address
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Address Line | 25330 SILVER ASPEN WAY APT 1221
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City | VALENCIA
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State | CA
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Zip | 91381-0731
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Country | US
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Telephone | 661-210-7205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP95035078
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95035078
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License Number State | CA
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