| Doctor Name: | MRS. JESSICA MAE MOODY |
| NPI Number: | 1043349400 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHYSICIAN ASSISTANT |
| License Number: | 3474 |
| Business Practice Address: | 14780 W Mountain View Blvd Ste 110 Surprise, AZ - 853747280 |
| Business Phone Number: | 6233747774 |
| Business Fax Number: | |
| Mailing Address: | 28727 N 20th Ave, PHOENIX |
| State: | AZ |
| Postal Code: | 850850727 |
| Phone Number: | 5207800129 |
| Fax Number: | |
| NPI Enumeration Date: | 03/03/2007 |
| NPI Last Update Date: | 11/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 3474 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |