MS. NOREEN TRESA JACK-MOONEY PA-C NPI 1831105287

NPI Information

NPI: 1831105287
Provider Name: MS. NOREEN TRESA JACK-MOONEY, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
80 B VETERANS BLVD
I-40, EXIT 102
ACOMA, NM
ZIP 87034
Phone: (505) 552-5300
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MS. Noreen Tresa Jack-mooney, PA-C is a medical physician assistant in Acoma, NM. MS. Noreen Tresa Jack-mooney, PA-C NPI is 1831105287. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

80 B VETERANS BLVD
I-40, EXIT 102
ACOMA, NM
ZIP 87034
Phone: (505) 552-5300
Fax: (505) 552-5828

The NPI 1831105287 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/31/2006 and was last updated on 4/24/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	AMD-276	HAWAII	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	H3451	MEDICAID	NEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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