Provider Demographics
NPI:1154608859
Name:MOODY, BROOKE SHOEMAKER (CRNP)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:SHOEMAKER
Last Name:MOODY
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 ROSEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35769-3960
Mailing Address - Country:US
Mailing Address - Phone:205-915-3910
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY WELLNESS CENTER 604 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37383-3763
Practice Address - Country:US
Practice Address - Phone:931-598-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-116290363LF0000X
TN30794363LS0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool