Healthcare Provider Details

I. General information

NPI: 1235791963
Provider Name (Legal Business Name): Y'MINE M. MCCLANAHAN MALIK DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 JOHNSTON ST STE B
LAFAYETTE LA
70503-6202
US

IV. Provider business mailing address

PO BOX 41402
BATON ROUGE LA
70835-1402
US

V. Phone/Fax

Practice location:
  • Phone: 337-326-5702
  • Fax:
Mailing address:
  • Phone: 504-327-1693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206489
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: