Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 20740 | TN |
NPI | 1063886091 |
---|---|
Provider Name | Mrs. Lauren Goodson Moody |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-5905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2015 |
Last Update Date | 21/10/2020 |