MEDICARE: MRS. LIZABETH MOONEY

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
1	385H00000X	Respite Care		MH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190741720004	OTHER	MO	DRIVERS LICENSE

General Provider Information

NPI Number	:	1841894391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIZABETH MOONEY

Provider Business Mailing Address
First Line	:	243 SE 15TH RD
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-9272
Country	:	US
Telephone Number	:	417-214-3801
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 SE 15TH RD
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-9272
Country	:	US
Telephone Number	:	417-214-3801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	11/25/2020

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Directions to “ MRS. LIZABETH MOONEY ” Practice Location

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