Individual
MRS. JESSICA MAE MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
11201 N TATUM BLVD STE 300, PHOENIX, AZ 85028-6039
(480) 900-3556
Mailing address
28727 N 20TH AVE, PHOENIX, AZ 85085-0727
(520) 780-0129
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3474
AZ
363AS0400X
Surgical Physician Assistant
3474
AZ
Other
Enumeration date
03/03/2007
Last updated
03/31/2023
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