Provider Demographics
NPI:1508750274
Name:MOONEYHAM, JAMIE (FNP-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MOONEYHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10616 W FARM ROAD 132
Mailing Address - Street 2:
Mailing Address - City:BOIS D ARC
Mailing Address - State:MO
Mailing Address - Zip Code:65612-7122
Mailing Address - Country:US
Mailing Address - Phone:417-988-8502
Mailing Address - Fax:
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-269-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025020703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily