Individual
DERICK W MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
672 W 400 S STE 201, SPRINGVILLE, UT 84663-3170
(801) 369-8989
(801) 704-9741
Mailing address
672 W 400 S, STE 201, SPRINGVILLE, UT 84663-3170
(801) 812-4673
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
8820342-1206
UT
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
8820342-1206
UT
Other
Enumeration date
01/07/2014
Last updated
09/07/2023
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