Healthcare Provider Details

I. General information

NPI: 1467749002
Provider Name (Legal Business Name): CRYSTLE SYON'TZE MALONE MS, PBSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2011
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2998 SMACKOVER HWY
EL DORADO AR
71730-8366
US

IV. Provider business mailing address

2998 SMACKOVER HWY
EL DORADO AR
71730-8366
US

V. Phone/Fax

Practice location:
  • Phone: 870-440-7884
  • Fax:
Mailing address:
  • Phone: 870-440-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: