Individual
MANDY SUZANNE MOONEYHAM
Active
Individual
MANDY SUZANNE MOONEYHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
2007002747
MO
363AS0400X
Surgical Physician Assistant
2266
OK
363AS0400X
Surgical Physician Assistant
P-T0716
AR
363AS0400X
Surgical Physician Assistant
Primary
PA-329
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0223808
DEPARTMENT OF LABOR WA
WA
01
—
219705
BLUE CROSS/BLUE SHIELD
MO
05
—
502277007
—
MO
Enumeration date
06/04/2007
Last updated
11/22/2013
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