Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 3013453 | KY |
NPI | 1467009514 |
---|---|
Provider Name | Dr. Alexandra Michele Malone |
First Address | Fayetteville, AR 72704-7914 |
Second Address | Lexington, KY 40536-7001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2019 |
Last Update Date | 22/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3013453 | APRN LICENSURE (01) | KY |