Provider Demographics
NPI:1841061991
Name:MOODY, CARRIE MARIE (RDN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:MOODY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9026 W ALEX AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2488
Mailing Address - Country:US
Mailing Address - Phone:602-550-2259
Mailing Address - Fax:
Practice Address - Street 1:9026 W ALEX AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2488
Practice Address - Country:US
Practice Address - Phone:602-550-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered