Provider Demographics
NPI:1356172886
Name:MOODY, TASHA RACHELLE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:TASHA
Middle Name:RACHELLE
Last Name:MOODY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MICHAEL JOHN DR
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-3387
Mailing Address - Country:US
Mailing Address - Phone:318-332-6244
Mailing Address - Fax:
Practice Address - Street 1:119 MICHAEL JOHN DR
Practice Address - Street 2:
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555-3387
Practice Address - Country:US
Practice Address - Phone:318-332-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA237084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily