Provider Demographics
NPI:1033696141
Name:MOON, YOU JONG ALYSSA (FNP-C)
Entity Type:Individual
Prefix:
First Name:YOU JONG
Middle Name:ALYSSA
Last Name:MOON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6429 BANNINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1345
Mailing Address - Country:US
Mailing Address - Phone:704-503-9338
Mailing Address - Fax:704-503-9339
Practice Address - Street 1:6429 BANNINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1345
Practice Address - Country:US
Practice Address - Phone:704-503-9338
Practice Address - Fax:704-503-9339
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176271363LF0000X
NC5016355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily