Healthcare Provider Details

I. General information

NPI: 1295706943
Provider Name (Legal Business Name): HARRIET PEARSON MALLICOAT ARNP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HATSIE MALLICOAT ARNP. CNM

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E SANTA FE ST
OLATHE KS
66061-3462
US

IV. Provider business mailing address

24417 W 114TH ST
OLATHE KS
66061-7333
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-1662
  • Fax:
Mailing address:
  • Phone: 913-780-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number45064
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number64080
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number034959
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number034959
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: