Healthcare Provider Details

I. General information

NPI: 1932416179
Provider Name (Legal Business Name): OSRIC ARMAND MALONE-PRIOLEAU APRN, CRC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 2ND ST
SAINT MARYS WV
26170-1097
US

IV. Provider business mailing address

210 2ND ST
SAINT MARYS WV
26170-1097
US

V. Phone/Fax

Practice location:
  • Phone: 304-699-1419
  • Fax: 304-586-6424
Mailing address:
  • Phone: 304-699-1419
  • Fax: 304-586-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010007619
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number78769
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number00105259
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00105259
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number78679
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: