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NPI Code Detail

MEDICARE: HEIDI MOODY

MEDICARE: HEIDI 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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1982217162
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI MOODY
Provider Business Mailing Address
First Line : 14204 N 76TH EAST AVE
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-4914
Country : US
Telephone Number : 918-206-5618
Fax Number :
Provider Business Practice Location Address
First Line : 6161 S YALE AVE
Second Line :
City : TULSA
State : OK
Zip : 74136-1902
Country : US
Telephone Number : 469-420-5544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2020
Last Update Date : 12/30/2025

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Directions to “ HEIDI MOODY ” Practice Location

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