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General NPI Number Information
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NPI Number | 1619698917
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Entity Type | Individual
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Provider Name | MALAINA PICKERING SIBLEY FNP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 1054 SW RAILROAD AVE
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City | PONCHATOULA
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State | LA
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Zip | 70454-3557
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Country | US
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Telephone | 985-401-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 13 AMAR DR
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City | HAMMOND
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State | LA
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Zip | 70401-1003
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Country | US
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Telephone | 985-351-0450
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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 | 227285
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License Number State | LA
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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 | 227285
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License Number State | LA
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