Mandy Suzanne Mooneyham, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA-329 Issued in AR

Practice address

3053 N College Ave
Fayetteville, AR 72703-3417

Phone

(479) 463-2000

Fax

(479) 442-4518

NPI assigned

Jun 4, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Mandy Suzanne Selvey Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385078400000",
    "number": "1831391655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3053 N COLLEGE AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033417",
            "telephone_number": "479-463-2000",
            "fax_number": "479-442-4518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3053 N COLLEGE AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033417",
            "telephone_number": "479-463-2000",
            "fax_number": "479-442-4518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOONEYHAM",
        "first_name": "MANDY",
        "middle_name": "SUZANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-04",
        "last_updated": "2013-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AR",
            "license": "PA-329",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MO",
            "license": "2007002747",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AR",
            "license": "P-T0716",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "2266",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "219705",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502277007",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR WA",
            "identifier": "0223808",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "SELVEY",
            "middle_name": "SUZANNE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Janet K Montgomery, SLP
• Roger C Montgomery, M.D.
• Bobbi L Moon, LMSW
• Karen Melissa Moon, LCSW
• Tiffany Mooney, D.P.T
• Aleigh Marie Moore-Masterson, BT
• Andrew Moore
• Bailie N Moore, APRN
• Bradley Dale Moore, MHPP
• James Franklin Moore, M.D.

• Surgical Physician Assistant in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Surgical Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; 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.