Individual
DR. VIRGINIA J MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
405 KAYS DRIVE, SUITE B, NORMAL, IL 61761
(309) 862-0064
(309) 862-1542
Mailing address
405 KAYS DRIVE, SUITE B, NORMAL, IL 61761
(309) 862-0064
(309) 862-1542
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
36101578
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067425
HEALTH ALLIANCE
—
01
—
260051695
RR MEDICARE
—
01
—
437668
HEALTH LINK
—
01
—
5723204
BCBS
—
Enumeration date
11/02/2006
Last updated
07/17/2014
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