Wylie Masterson Moody, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

V8697 Issued in TX

Practice address

6404 Nursery Dr Ste 201
Victoria, TX 77904-1688

Phone

(361) 724-3864

Fax

(361) 288-3075

NPI assigned

Mar 30, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of Texas Medical School at Houston, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wylie Moody, MD

  • Dermatology Physician
  • Victoria, TX
  • NPI 1184582215
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1740920529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6404 NURSERY DR STE 201",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779041688",
            "telephone_number": "361-724-3864",
            "fax_number": "361-288-3075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6404 NURSERY DR STE 201",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779041688",
            "telephone_number": "361-724-3864",
            "fax_number": "361-288-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "WYLIE",
        "middle_name": "MASTERSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-30",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "V8697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Monette
• Patricia K Monroe, LPC
• Ignacio Montemayor Jr., M.D.
• Marisol Montes-Ortiz, MD
• Derek Lee Moody
• Amanda Moore, PHARMACIST
• Desiree Young Moore, NP
• Kathryn Jane Moore, R.PH.
• Kimberly A Moore, MD
• Megan Moore, LPC

• Dermatology Physician in Victoria, TX
• Providers in Victoria, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.