Provider Demographics
NPI:1497073332
Name:MOODY, BRENDA SUE
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:MOODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 NORTHRIDGE RUN
Mailing Address - Street 2:
Mailing Address - City:CASHION
Mailing Address - State:OK
Mailing Address - Zip Code:73016-9426
Mailing Address - Country:US
Mailing Address - Phone:405-471-3523
Mailing Address - Fax:
Practice Address - Street 1:5620 NORTHRIDGE RUN
Practice Address - Street 2:
Practice Address - City:CASHION
Practice Address - State:OK
Practice Address - Zip Code:73016-9426
Practice Address - Country:US
Practice Address - Phone:405-471-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-16
Last Update Date:2010-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator