Provider Demographics
NPI:1750852588
Name:MOONEY, BRIAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MOONEY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4226
Mailing Address - Country:US
Mailing Address - Phone:304-228-9156
Mailing Address - Fax:
Practice Address - Street 1:310 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4226
Practice Address - Country:US
Practice Address - Phone:304-228-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN68787-FNP-BC363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner