Provider Demographics
NPI:1831928720
Name:MOODY, ELIZABETH GRACE (RDN/LD, CSOWM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRACE
Last Name:MOODY
Suffix:
Gender:F
Credentials:RDN/LD, CSOWM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 W MAIN ST # 1049
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-2221
Mailing Address - Country:US
Mailing Address - Phone:405-777-7261
Mailing Address - Fax:405-337-9672
Practice Address - Street 1:1004 SHADOWLAKE RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6877
Practice Address - Country:US
Practice Address - Phone:405-973-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1849133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered