MANDY SUZANNE MOONEYHAM PA-C NPI 1831391655

NPI Information

NPI: 1831391655
Provider Name: MANDY SUZANNE MOONEYHAM, PA-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
3053 N COLLEGE AVE
FAYETTEVILLE, AR
ZIP 72703
Phone: (479) 463-2000
Get Directions

Mandy Suzanne Mooneyham, PA-C is a surgical physician assistant in Fayetteville, AR. Mandy Suzanne Mooneyham, PA-C NPI is 1831391655. 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:

3053 N COLLEGE AVE
FAYETTEVILLE, AR
ZIP 72703-417
Phone: (479) 463-2000
Fax: (479) 442-4518

The NPI 1831391655 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 6/4/2007 and was last updated on 11/22/2013.

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	363AS0400X	Physician Assistant	Surgical	P-T0716	ARKANSAS	No
2	363AS0400X	Physician Assistant	Surgical	2007002747	MISSOURI	No
3	363AS0400X	Physician Assistant	Surgical	2266	OKLAHOMA	No
4	363AS0400X	Physician Assistant	Surgical	PA-329	ARKANSAS	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	502277007	MEDICAID	MISSOURI
2	P00478908	MEDICARE PIN	MISSOURI
3	219705	OTHER	MISSOURI	BLUE CROSS/BLUE SHIELD
4	0223808	OTHER	WASHINGTON	DEPARTMENT OF LABOR WA
5	000097457	MEDICARE PIN	MISSOURI

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: 4/28/2024

NPI Synchronization or Removal

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