Active NPI
Ethan Andrew Mooney, ATC
- Athletic Trainer
- Melbourne, FL
National Provider Identifier
1790466969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 7000
- Practice address
- 3320 Dairy Rd
Melbourne, FL 32904-7604 - Phone
- (321) 745-0579
- NPI assigned
- Jul 31, 2023
- Last updated
- Jul 31, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 7000 | FL | Primary |
Addresses
Primary practice location
3320 Dairy Rd
Melbourne, FL 32904-7604
Mailing address
3320 Dairy Rd
Melbourne, FL 32904-7604
Phone (321) 745-0579
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7000 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690761600000",
"number": "1790466969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3320 DAIRY RD",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329047604",
"telephone_number": "321-745-0579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3320 DAIRY RD",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329047604",
"telephone_number": "321-745-0579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOONEY",
"first_name": "ETHAN",
"middle_name": "ANDREW",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-31",
"last_updated": "2023-07-31",
"certification_date": "2023-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "7000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.