Healthcare Provider Details

I. General information

NPI: 1023155710
Provider Name (Legal Business Name): JAMIE LYNN MALONE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LYNN BOGGS RN

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 61ST ST
BROOKLYN NY
11204-2110
US

IV. Provider business mailing address

1649 61ST ST
BROOKLYN NY
11204-2110
US

V. Phone/Fax

Practice location:
  • Phone: 212-481-4040
  • Fax:
Mailing address:
  • Phone: 212-481-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 1349109041
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number74676
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number46090
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: