Provider Demographics
NPI:1477599876
Name:MOONEY, JEAN BARNETT (PED NURSE PRACTITION)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:BARNETT
Last Name:MOONEY
Suffix:
Gender:F
Credentials:PED NURSE PRACTITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 NORTH ROAD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454
Mailing Address - Country:US
Mailing Address - Phone:585-243-4000
Mailing Address - Fax:585-243-4002
Practice Address - Street 1:3889 NORTH ROAD
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-243-4000
Practice Address - Fax:585-243-4002
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3801651208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
109217DLOtherPFC
02258184OtherMED
000926885001OtherHNN