Provider Demographics
NPI:1184606360
Name:MOODY, PAMELA KAY (PHD, DNP, APRN-BC)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:KAY
Last Name:MOODY
Suffix:
Gender:F
Credentials:PHD, DNP, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11589 COUNCIL BARBER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-5501
Mailing Address - Country:US
Mailing Address - Phone:205-799-9108
Mailing Address - Fax:
Practice Address - Street 1:2350 HARGROVE RD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-2612
Practice Address - Country:US
Practice Address - Phone:205-554-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-033023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily