Provider Demographics
NPI:1609011725
Name:MOODY, DEBORAH SUE (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:MOODY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:SUE
Other - Last Name:GARRETSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-0072
Mailing Address - Country:US
Mailing Address - Phone:254-675-8621
Mailing Address - Fax:254-675-2254
Practice Address - Street 1:201 POSEY AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1200
Practice Address - Country:US
Practice Address - Phone:254-675-8621
Practice Address - Fax:254-675-2254
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201515802Medicaid
TX201515801Medicaid