MEDICARE: KRISTEN BANKS MALINOWSKI PMHNP

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	5017910	NC

General Provider Information

NPI Number	:	1790472231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN BANKS MALINOWSKI PMHNP

Provider Business Mailing Address
First Line	:	1695 KERNERSVILLE MEDICAL PKWY
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7159
Country	:	US
Telephone Number	:	336-515-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1695 KERNERSVILLE MEDICAL PKWY
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7159
Country	:	US
Telephone Number	:	336-515-5000
Fax Number	:

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	01/27/2026

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