Provider Demographics
NPI:1750129425
Name:MOONEY, PRIYANKA SUZANNE
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:SUZANNE
Last Name:MOONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12881 N IH 35
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2966
Mailing Address - Country:US
Mailing Address - Phone:210-742-6555
Mailing Address - Fax:224-623-0079
Practice Address - Street 1:17766 VERDE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-2226
Practice Address - Country:US
Practice Address - Phone:210-742-6555
Practice Address - Fax:224-623-0079
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily