Individual
LESLIE W MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 MERCY WAY, JOPLIN, MO 64804-4524
(417) 556-3570
Mailing address
PO BOX 504944, SAINT LOUIS, MO 63150-4944
(417) 820-4620
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2000166139
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
RR MEDICARE
MO
05
—
PENDING
—
KS
05
—
PENDING
—
MO
05
—
PENDING
—
OK
Enumeration date
02/01/2007
Last updated
12/03/2015
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