Provider Demographics
NPI:1134156748
Name:MOONEY, NICOLE E (ATC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:MOONEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5926 ANTIQUA LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-5181
Mailing Address - Country:US
Mailing Address - Phone:865-212-0182
Mailing Address - Fax:865-524-2169
Practice Address - Street 1:4307 BALL CAMP PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3313
Practice Address - Country:US
Practice Address - Phone:865-524-1234
Practice Address - Fax:865-524-2169
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer