Healthcare Provider Details

I. General information

NPI: 1619698917
Provider Name (Legal Business Name): MALAINA PICKERING SIBLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALAINA BROOKE PICKERING

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 SW RAILROAD AVE
PONCHATOULA LA
70454-3557
US

IV. Provider business mailing address

13 AMAR DR
HAMMOND LA
70401-1003
US

V. Phone/Fax

Practice location:
  • Phone: 985-401-9711
  • Fax:
Mailing address:
  • Phone: 985-351-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227285
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number227285
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: