Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 46090 | KS |
NPI | 1023155710 |
---|---|
Provider Name | Mrs. Jamie Lynn Malone |
First Address | Hays, KS 67601 |
Second Address | Hays, KS 67601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 04/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160178 | BC BS (01) | |
S71131 | (02) |