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General NPI Number Information
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NPI Number | 1043705726
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Entity Type | Individual
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Provider Name | KELLY NICOLE MALCOM APRN
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Gender | Female
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 3907 CENTRAL AVE STE J
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City | HOT SPRINGS
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State | AR
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Zip | 71913-7249
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Country | US
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Telephone | 501-781-3122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | OKOLONA
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State | AR
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Zip | 71962-0057
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Country | US
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Telephone | 870-210-0230
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | A005705
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License Number State | AR
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