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General NPI Number Information
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NPI Number | 1578290557
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Entity Type | Individual
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Provider Name | JACOB BYRON MALONEY FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 232 MARKET ST
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City | FLOWOOD
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State | MS
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Zip | 39232-3339
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Country | US
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Telephone | 888-551-2538
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Fax | 844-364-2629
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Provider Business Mailing Address
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Address Line | 232 MARKET ST
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City | FLOWOOD
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State | MS
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Zip | 39232-3339
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Country | US
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Telephone | 888-851-2538
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Fax | 844-364-2629
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-147307
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 905804
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License Number State | MS
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