Provider Demographics
NPI:1538713839
Name:DOTY MOODY, MORGAN ARIEL (APRN)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:ARIEL
Last Name:DOTY MOODY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:ARIEL
Other - Last Name:DOTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:501 BAY POINTE CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8631
Mailing Address - Country:US
Mailing Address - Phone:601-405-4334
Mailing Address - Fax:
Practice Address - Street 1:102 LEXINGTON DR STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6952
Practice Address - Country:US
Practice Address - Phone:601-973-1688
Practice Address - Fax:601-973-1690
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903443363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty