MEDICARE: MRS. KRISTI HOLLAND MOODY APRN, CPNP

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
1	363LP0200X	Pediatric Nurse Practitioner	AP04909	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437268547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTI HOLLAND MOODY APRN, CPNP

Provider Business Mailing Address
First Line	:	30892 HIGHWAY 43
Second Line	:
City	:	ALBANY
State	:	LA
Zip	:	70711-2814
Country	:	US
Telephone Number	:	225-567-2812
Fax Number	:	985-543-0567

Provider Business Practice Location Address
First Line	:	42124 VETERANS AVE
Second Line	:	STE A
City	:	HAMMOND
State	:	LA
Zip	:	70403-1427
Country	:	US
Telephone Number	:	985-543-0565
Fax Number	:	985-543-0567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/01/2011

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