Provider Demographics
NPI:1134570500
Name:MOONEYHAM, JEFFERY H (CRNP)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:H
Last Name:MOONEYHAM
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:JEFFERY
Other - Middle Name:H
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:206 OHARA DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-2596
Mailing Address - Country:US
Mailing Address - Phone:256-243-2430
Mailing Address - Fax:
Practice Address - Street 1:4350 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:AL
Practice Address - Zip Code:35952
Practice Address - Country:US
Practice Address - Phone:205-589-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109518363LF0000X
AL1109518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily