Provider Demographics
NPI:1265798904
Name:MOOMEY, JEFFREY P (RNFA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:MOOMEY
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7827 HIGHWAY N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6704
Mailing Address - Country:US
Mailing Address - Phone:314-620-1672
Mailing Address - Fax:636-561-7159
Practice Address - Street 1:7827 HIGHWAY N
Practice Address - Street 2:SUITE 104
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6704
Practice Address - Country:US
Practice Address - Phone:314-620-1672
Practice Address - Fax:636-561-7159
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO071732163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant