Healthcare Provider Details

I. General information

NPI: 1497504252
Provider Name (Legal Business Name): JESSICA LYNN MALAHY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 E MAIN ST
JACKSON MO
63755-2582
US

IV. Provider business mailing address

2685 E MAIN ST
JACKSON MO
63755-2582
US

V. Phone/Fax

Practice location:
  • Phone: 573-204-1400
  • Fax:
Mailing address:
  • Phone: 573-204-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08220360
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: