Healthcare Provider Details

I. General information

NPI: 1073853388
Provider Name (Legal Business Name): PATRICIA M. MALONE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA M HESTER RN

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 5TH ST N
COLUMBUS MS
39705-2008
US

IV. Provider business mailing address

2520 5TH ST N
COLUMBUS MS
39705-2008
US

V. Phone/Fax

Practice location:
  • Phone: 662-244-2561
  • Fax: 662-286-6971
Mailing address:
  • Phone: 662-244-2561
  • Fax: 662-286-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number903758
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: