MEDICARE: MR. KEVIN WAYNE MALONE SR. FNP

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	363LF0000X	Family Nurse Practitioner	AP145660	TX

General Provider Information

NPI Number	:	1639832785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN WAYNE MALONE SR. FNP

Provider Business Mailing Address
First Line	:	8544 W BELLFORT AVE # 606
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2208
Country	:	US
Telephone Number	:	713-399-6669
Fax Number	:	888-892-4091

Provider Business Practice Location Address
First Line	:	8544 W BELLFORT AVE # 606
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2208
Country	:	US
Telephone Number	:	713-399-6669
Fax Number	:	888-892-4091

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

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	09/19/2024

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