Provider Demographics
NPI:1962548685
Name:MOODY, NEIL FRANKLIN JR (PA-C)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:FRANKLIN
Last Name:MOODY
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-245-9045
Mailing Address - Fax:
Practice Address - Street 1:2301 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4143
Practice Address - Country:US
Practice Address - Phone:254-628-5454
Practice Address - Fax:254-628-2729
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004174363A00000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant