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NPI Code Detail

MEDICARE: MS. JULIE ALISHA MOONEY PA

MEDICARE: MS. JULIE ALISHA MOONEY PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363AM0700XMedical Physician Assistant13095322-1206UT

General Provider Information

NPI Number : 1578100434
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JULIE ALISHA MOONEY PA
Provider Business Mailing Address
First Line : 2965 W 3500 S
Second Line :
City : WEST VALLEY CITY
State : UT
Zip : 84119-3602
Country : US
Telephone Number : 801-965-3600
Fax Number :
Provider Business Practice Location Address
First Line : 3186 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2317
Country : US
Telephone Number : 702-691-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2019
Last Update Date : 04/09/2026

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