Provider Demographics
NPI:1457233785
Name:MOONEY, KAITLIN HALEY (PHARMD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:HALEY
Last Name:MOONEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12770 BROOKSIE THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:BATH SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:38311-4250
Mailing Address - Country:US
Mailing Address - Phone:731-733-4034
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:731-733-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC337981835C0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0206XPharmacy Service ProvidersPharmacistCardiology