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NPI Code Detail

MEDICARE: JESSICA LYNN MOODY CRNP

MEDICARE: JESSICA LYNN MOODY CRNP
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
1163W00000XRegistered Nurse1-180707AL
2363LP0808XPsychiatric/Mental Health Nurse Practitioner1-180707AL

General Provider Information

NPI Number : 1467033530
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNN MOODY CRNP
Provider Business Mailing Address
First Line : 7125 UNIVERSITY CT
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8016
Country : US
Telephone Number : 334-239-2622
Fax Number :
Provider Business Practice Location Address
First Line : 7125 UNIVERSITY CT
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8016
Country : US
Telephone Number : 334-239-2622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2021
Last Update Date : 11/09/2022

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