Healthcare Provider Details

I. General information

NPI: 1275532624
Provider Name (Legal Business Name): JENNIFER MALMSTROM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CENTRE VIEW BLVD
CRESTVIEW HILLS KY
41017-3476
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-3015
  • Fax: 593-413-2158
Mailing address:
  • Phone: 859-341-3015
  • Fax: 859-341-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030545
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3004448
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: