Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 3007856 | KY |
NPI | 1023356649 |
---|---|
Provider Name | Ms. Heather J Moody |
First Address | Louisville, KY 40202-3849 |
Second Address | Louisville, KY 40202-3849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2013 |
Last Update Date | 12/02/2013 |