Nicholas R Moorehead, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810008333 Issued in VA

Practice address

2630 Central Ave # 3349
Eielson AFB, AK 99702-2301

Phone

(907) 377-3071

NPI assigned

May 15, 2022

Last updated

Oct 23, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1652572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1417694159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 CENTRAL AVE # 3349",
            "city": "EIELSON AFB",
            "state": "AK",
            "postal_code": "997022301",
            "telephone_number": "907-377-3071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 CENTRAL AVE # 3349",
            "city": "EIELSON AFB",
            "state": "AK",
            "postal_code": "997022301",
            "telephone_number": "907-377-3071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Wilford Hall Loop",
            "address_purpose": "LOCATION",
            "city": "Jbsa Lackland",
            "state": "TX",
            "postal_code": "782365638",
            "country_code": "US",
            "telephone_number": "210-292-5972",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOOREHEAD",
        "first_name": "NICHOLAS",
        "middle_name": "R",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-15",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810008333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley Martin
• Eric Dylan Mason, IDMT
• Karen L Medbury, MSW, LCSW
• Landru Derek Medvec, IDMT
• Jacob A Mock, PHARMD, BCGP
• Sandra Muniz, LPN
• Amanda Nichols
• Eric Noll, OD
• John Joseph Olshefski, M.D.
• Robert Greg Patterson, M.D.

• Clinical Psychologist in Eielson AFB, AK
• Providers in Eielson AFB, AK by specialty
• Clinical Psychologist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.