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NPI Code Detail

MEDICARE: DELISSIA MOODY

MEDICARE: DELISSIA MOODY
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 NurseRN154807LA
2163WM0102XMaternal Newborn Registered NurseRN154807LA

General Provider Information

NPI Number : 1588544811
Entity Type Code : Individual
Provider Name (Legal Business Name) : DELISSIA MOODY
Provider Business Mailing Address
First Line : 1472 W FAIRVIEW DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-1417
Country : US
Telephone Number : 225-907-6058
Fax Number :
Provider Business Practice Location Address
First Line : 1472 W FAIRVIEW DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-1417
Country : US
Telephone Number : 225-907-6058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2025
Last Update Date : 09/05/2025

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Directions to “ DELISSIA MOODY ” Practice Location

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