Mooneyham, Mandy Suzanne

Mooneyham, Mandy Suzanne is an individual health care provider with primary practice located at 3053 N College Ave , Fayetteville AR 72703-3417. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as her primary health care specialty. Mooneyham, Mandy Suzanne can be contacted via phone (479) 463-2000.

Contact Information

Primary practice address
3053 N College Ave Fayetteville AR 72703-3417
Phone: (479) 463-2000
Fax: (479) 442-4518
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA-329 Arkansas
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 2007002747 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X P-T0716 Arkansas
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 2266 Oklahoma

Profile Details

NPI number 1831391655
LBN Legal business name Mooneyham, Mandy Suzanne
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 4th, 2007
Last updated Nov 22nd, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831391655 NPPES
Missouri Other 219705 BLUE CROSS/BLUE SHIELD
Missouri MEDICAID 502277007 BLUE CROSS/BLUE SHIELD
Missouri Other 0223808 BLUE CROSS/BLUE SHIELD

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