Healthcare Provider Details

I. General information

NPI: 1750813242
Provider Name (Legal Business Name): CASSANDRA MALONE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 KINGSTON PIKE
KNOXVILLE TN
37919-5026
US

IV. Provider business mailing address

333 COMMERCE ST STE 700
NASHVILLE TN
37201-1835
US

V. Phone/Fax

Practice location:
  • Phone: 865-978-6182
  • Fax:
Mailing address:
  • Phone: 615-627-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number178116
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22933
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: