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NPI Code Detail

MEDICARE: JENNFIER MALCOLM PNP

MEDICARE: JENNFIER MALCOLM PNP
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
1363LP0200XPediatric Nurse Practitioner71018285AIN

General Provider Information

NPI Number : 1801722582
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNFIER MALCOLM PNP
Provider Business Mailing Address
First Line : 17 ORIOLE DR
Second Line :
City : LAFAYETTE
State : IN
Zip : 47905-8787
Country : US
Telephone Number : 219-869-1852
Fax Number : 219-869-1852
Provider Business Practice Location Address
First Line : 705 RILEY HOSPITAL DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5109
Country : US
Telephone Number : 317-944-2143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2026
Last Update Date : 06/22/2026

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