Provider Demographics
NPI:1306243431
Name:MOONEY, JANET (NP-C)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MOONEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SEMINOLE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-8169
Mailing Address - Country:US
Mailing Address - Phone:615-708-5883
Mailing Address - Fax:
Practice Address - Street 1:330 FRANKLIN RD STE 135-A270
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3280
Practice Address - Country:US
Practice Address - Phone:615-274-9767
Practice Address - Fax:615-807-4811
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF0914357363LF0000X
TN18868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103500I288Medicare PIN