Healthcare Provider Details

I. General information

NPI: 1912879024
Provider Name (Legal Business Name): MEAGAN ELAINE MALONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

3640 OLD STAGE RD
SPRING VALLEY OH
45370-9731
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-3611
  • Fax:
Mailing address:
  • Phone: 937-815-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0040329
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: