Provider Demographics
NPI:1558146928
Name:MOODY, LAUREN CHRISTINE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CHRISTINE
Last Name:MOODY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 SHALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3019
Mailing Address - Country:US
Mailing Address - Phone:850-212-6094
Mailing Address - Fax:
Practice Address - Street 1:2181 ORANGE AVE E
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-6144
Practice Address - Country:US
Practice Address - Phone:850-513-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12298133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered