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General NPI Number Information
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NPI Number | 1447674114
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Entity Type | Individual
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Provider Name | KEVIN MALICKY CRNP F-NP
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Gender | Male
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Dates
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Enumeration Date | 02/14/2014
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 1225 WARM SPRINGS AVE
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City | HUNTINGDON
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State | PA
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Zip | 16652-2350
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Country | US
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Telephone | 818-643-8485
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Fax | 814-643-8755
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Provider Business Mailing Address
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Address Line | 153 FREDERICK RD
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City | ALTOONA
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State | PA
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Zip | 16602-7475
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Country | US
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Telephone | 814-937-4147
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F0214324
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License Number State | PA
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