Provider Demographics
NPI:1609979426
Name:MOONEY, DARA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DARA
Middle Name:M
Last Name:MOONEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:783
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-7027
Mailing Address - Fax:501-296-1307
Practice Address - Street 1:1003 SCHNEIDER DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4811
Practice Address - Country:US
Practice Address - Phone:501-337-5678
Practice Address - Fax:501-332-6759
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1345393Medicaid
LAP476Medicare ID - Type UnspecifiedPA-C
LAP82977Medicare UPIN