| Doctor Name: | MARY CATHERINE MOODY |
| NPI Number: | 1891193744 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | AP126911 |
| Business Practice Address: | 2418 W Main St Gun Barrel City, TX - 751563638 |
| Business Phone Number: | 9037132000 |
| Business Fax Number: | 9037132004 |
| Mailing Address: | 2418 W Main St, GUN BARREL CITY |
| State: | TX |
| Postal Code: | 751563638 |
| Phone Number: | 9037132000 |
| Fax Number: | 9037132004 |
| NPI Enumeration Date: | 12/09/2014 |
| NPI Last Update Date: | 12/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP126911 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |