Individual
KAYLA MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
15755 SW SEQUOIA PKWY, TIGARD, OR 97224-7166
(503) 639-6002
Mailing address
4351 SE 28TH PL, PORTLAND, OR 97202-3519
(512) 784-4293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA190342
OR
Other
Enumeration date
10/23/2018
Last updated
10/20/2020
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