Provider Demographics
NPI:1992344121
Name:MOODY, KAREN VIRGINIA (MS RD LDN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:VIRGINIA
Last Name:MOODY
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8710
Mailing Address - Country:US
Mailing Address - Phone:910-715-6268
Mailing Address - Fax:910-715-6279
Practice Address - Street 1:300 GATEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4822
Practice Address - Country:US
Practice Address - Phone:336-905-6080
Practice Address - Fax:336-905-6081
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005334133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered