Provider Demographics
NPI:1417901158
Name:MOODY, CATHRYN SUE (RNC, NNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHRYN
Middle Name:SUE
Last Name:MOODY
Suffix:
Gender:F
Credentials:RNC, NNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:482 STEPHEN F AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-3120
Mailing Address - Country:US
Mailing Address - Phone:936-321-5793
Mailing Address - Fax:281-364-2522
Practice Address - Street 1:9250 PINECROFT DR
Practice Address - Street 2:NEONATAL ICU
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3218
Practice Address - Country:US
Practice Address - Phone:281-364-5678
Practice Address - Fax:281-364-2522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX517171363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal