1417901158 NPI number — MRS. CATHRYN SUE MOODY RNC, NNP

Table of content: MRS. CATHRYN SUE MOODY RNC, NNP (NPI 1417901158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417901158 NPI number — MRS. CATHRYN SUE MOODY RNC, NNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOODY
Provider First Name:
CATHRYN
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RNC, NNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417901158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
482 STEPHEN F AUSTIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77302-3120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-321-5793
Provider Business Mailing Address Fax Number:
281-364-2522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9250 PINECROFT DR
Provider Second Line Business Practice Location Address:
NEONATAL ICU
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-364-5678
Provider Business Practice Location Address Fax Number:
281-364-2522
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0000X , with the licence number:  517171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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