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General NPI Number Information
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NPI Number | 1801722582
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Entity Type | Individual
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Provider Name | JENNFIER MALCOLM PNP
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Gender |
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 705 RILEY HOSPITAL DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5109
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Country | US
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Telephone | 317-944-2143
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Fax |
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Provider Business Mailing Address
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Address Line | 17 ORIOLE DR
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City | LAFAYETTE
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State | IN
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Zip | 47905-8787
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Country | US
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Telephone | 219-869-1852
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Fax | 219-869-1852
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 71018285A
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License Number State | IN
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