Nichole Mooney, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11101394-4405 Issued in UT

Practice address

902 Dilger Ave
Rapid City, SD 57701-0829

Phone

(801) 400-7382

NPI assigned

Sep 11, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Nichole Mertz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1265219471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 DILGER AVE",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577010829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 DILGER AVE",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577010829",
            "telephone_number": "801-400-7382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOONEY",
        "first_name": "NICHOLE",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-11",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "11101394-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLE",
            "last_name": "MERTZ",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Monument Health Rapid City Hospital, Inc. (Monument Health Rehabilitation Center)
• Monument Health Rapid City Hospital, Inc. (Monument Health General Surgery)
• Monument Health Rapid City Hospital. Inc. (Monument Health Rapid City Clinic, 5th Street)
• Moody Dental Implant Centers LLC
• Lisa R Moon, RN
• Tiffany Mooney, LPC-MH, QMHP
• Jodi Lynn Moore, RN
• Melissa H Moore, PTA
• Scott Moore
• Treese Morford Deboer, MSW, CSW-PIP

• Family Nurse Practitioner in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Family Nurse Practitioner in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.