MANDY SUZANNE MOONEYHAM (NPI# 1831391655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831391655 |
| Entity Type | Individual |
| Full Name | MANDY SUZANNE MOONEYHAM |
| Other Name | MANDY SUZANNE SELVEY |
| Credential | PA-C |
| Practice Address |
3053 N College Ave Fayetteville AR 72703-3417 |
| Practice Telephone | 4794632000 |
| Practice Fax Number | 4794424518 |
| Mailing Telephone | 4794632000 |
| Mailing Fax Number | 4794424518 |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2013-11-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA-329 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
2266 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
P-T0716 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
2007002747 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 502277007 | 05 | |
| MO | BLUE CROSS/BLUE SHIELD | 219705 | 01 |
| WA | DEPARTMENT OF LABOR WA | 0223808 | 01 |
| Street Address |
3053 N COLLEGE AVE |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-3417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083046635 | Jason David Kranenburg | Physician Assistant | 170 Hayden Ct, Fayetteville, GA 30215-2549 | 2013-08-06 |
| 1730266453 | Mary Lee Cudd | Physician Assistant | 1774 Metromedical Drive, Fayetteville, NC 28304 | 2006-11-01 |
| 1043318611 | Dena Marie Pozeg | Physician Assistant | 4140 Ferncreek Drive, Suite 601, Fayetteville, NC 28314-2569 | 2006-09-20 |
| 1407460843 | Alexandra Paige Brown | Physician Assistant | 1695 E Rainforest Rd, Fayetteville, AR 72703-5385 | 2020-09-02 |
| 1134668007 | Gerald Crist | Physician Assistant | 1638 Owen Dr, Fayetteville, NC 28304-3424 | 2017-02-13 |
| 1477941367 | Sarah Busbin | Physician Assistant | 4140 Ferncreek Dr, Suite 801, Fayetteville, NC 28314-2563 | 2014-12-31 |
| 1265820260 | Ashley Ronk | Physician Assistant | 4140 Ferncreek Dr, Suite 801, Fayetteville, NC 28314-2563 | 2014-12-30 |
| 1275894826 | Timothy Richard Key | Physician Assistant | 115 Edenton Estates Dr, Fayetteville, GA 30214-4442 | 2012-05-30 |
| 1932258993 | Alexandra Fischell Fitzgerald | Physician Assistant | 4140 Ferncreek Dr, Suite 801, Fayetteville, NC 28314-2563 | 2007-01-09 |
| 1881767580 | Cynthia Shawn Earl | Physician Assistant | 2300 Ramsey St, Fayetteville, NC 28301-3856 | 2006-11-17 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
Please comment or provide details below to improve the information on MANDY SUZANNE MOONEYHAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.