Provider Demographics
NPI:1518767649
Name:MOODY, KENYA G (NP)
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:G
Last Name:MOODY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LEVELFIELDS LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:VA
Mailing Address - Zip Code:22503-2016
Mailing Address - Country:US
Mailing Address - Phone:804-436-3487
Mailing Address - Fax:
Practice Address - Street 1:113 LEVELFIELDS LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:VA
Practice Address - Zip Code:22503-2016
Practice Address - Country:US
Practice Address - Phone:804-436-3487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192870363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health