Provider Demographics
NPI:1427603935
Name:MOONEY, JONATHAN WILLIAM (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:MOONEY
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3610
Mailing Address - Country:US
Mailing Address - Phone:309-671-8020
Mailing Address - Fax:309-671-8007
Practice Address - Street 1:228 NE JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3802
Practice Address - Country:US
Practice Address - Phone:309-671-8000
Practice Address - Fax:309-671-4695
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health