Healthcare Provider Details

I. General information

NPI: 1477066991
Provider Name (Legal Business Name): JESSICA TAYLOR MALCOLM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD STE 143
SCOTTSDALE AZ
85260-1503
US

IV. Provider business mailing address

9377 E BELL RD STE 143
SCOTTSDALE AZ
85260-1503
US

V. Phone/Fax

Practice location:
  • Phone: 480-619-4097
  • Fax: 480-619-4098
Mailing address:
  • Phone: 480-619-4097
  • Fax: 480-619-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10761
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: