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General NPI Number Information
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NPI Number | 1154608859
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Entity Type | Individual
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Provider Name | BROOKE SHOEMAKER MOODY CRNP
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Gender | Female
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | UNIVERSITY WELLNESS CENTER 604 UNIVERSITY AVENUE
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City | SEWANEE
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State | TN
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Zip | 37383-3763
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Country | US
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Telephone | 931-598-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 1807 ROSEBERRY DR
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City | SCOTTSBORO
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State | AL
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Zip | 35769-3960
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Country | US
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Telephone | 205-915-3910
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-116290
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LS0200X
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Taxonomy Name | School Nurse Practitioner
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License Number | 30794
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 30794
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License Number State | TN
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