Individual
KODY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-9800
(570) 214-7967
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA058390
PA
363A00000X
Physician Assistant
OA003864
PA
Other
Enumeration date
09/13/2016
Last updated
09/01/2020
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