MEDICARE: KELLY NICOLE MALCOM APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	A005705	AR

General Provider Information

NPI Number	:	1043705726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY NICOLE MALCOM APRN

Provider Business Mailing Address
First Line	:	135 SAWTOOTH OAK ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7160
Country	:	US
Telephone Number	:	501-781-3122
Fax Number	:	205-341-1270

Provider Business Practice Location Address
First Line	:	135 SAWTOOTH OAK ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7160
Country	:	US
Telephone Number	:	501-781-3122
Fax Number	:	205-341-1270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	03/12/2026

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