Provider Demographics
NPI:1043316011
Name:MOODY, LINDA C (RN MSN FNP PMHNP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:C
Last Name:MOODY
Suffix:
Gender:F
Credentials:RN MSN FNP PMHNP
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:C
Other - Last Name:ADAMS SICORE HACKNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:132 RIDGE CREST DR
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-5153
Mailing Address - Country:US
Mailing Address - Phone:972-978-4424
Mailing Address - Fax:
Practice Address - Street 1:4500S. LANCASTER RD STE IC143
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-857-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596044363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health