Healthcare Provider Details

I. General information

NPI: 1578452173
Provider Name (Legal Business Name): CAITLYN ELIZABETH MALLOY NIMS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLYN ELIZABETH MALLOY

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 KILPATRICK BLVD
MONROE LA
71201-5139
US

IV. Provider business mailing address

604 N ACADIA RD STE 101
THIBODAUX LA
70301-4897
US

V. Phone/Fax

Practice location:
  • Phone: 318-855-6282
  • Fax:
Mailing address:
  • Phone: 985-446-5079
  • Fax: 985-447-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215359
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: