Provider Demographics
NPI:1780483198
Name:MOODY NUTRITION LLC
Entity type:Organization
Organization Name:MOODY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN/LD, CSOWM
Authorized Official - Phone:405-973-7841
Mailing Address - Street 1:629 W MAIN ST # 1049
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-2221
Mailing Address - Country:US
Mailing Address - Phone:405-777-7261
Mailing Address - Fax:405-337-9671
Practice Address - Street 1:629 W MAIN ST # 1049
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-2221
Practice Address - Country:US
Practice Address - Phone:405-777-7261
Practice Address - Fax:405-337-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty