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General NPI Number Information
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NPI Number | 1023890340
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Entity Type | Individual
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Provider Name | SHAIKIA MALLETT
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Gender | Female
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 11402 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72211-2806
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Country | US
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Telephone | 501-482-3389
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 334
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City | COLLEGE STATION
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State | AR
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Zip | 72053-0334
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Country | US
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Telephone | 501-366-8294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 225969
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License Number State | AR
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