Individual
MANDY SUZANNE MOONEYHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3053 N COLLEGE AVE, FAYETTEVILLE, AR 72703-3417
(479) 463-2000
(479) 442-4518
Mailing address
3053 N COLLEGE AVE, FAYETTEVILLE, AR 72703-3417
(479) 463-2000
(479) 442-4518
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
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us