MEDICARE: HOLLY J MALONEY NP

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	363LF0000X	Family Nurse Practitioner	202071	NC
2	363LF0000X	Family Nurse Practitioner	F0116179 - CERT.	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831559996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY J MALONEY NP

Provider Business Mailing Address
First Line	:	1129 WESTERN BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6652
Country	:	US
Telephone Number	:	910-939-5388
Fax Number	:	910-939-5532

Provider Business Practice Location Address
First Line	:	1129 WESTERN BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6652
Country	:	US
Telephone Number	:	910-939-5388
Fax Number	:	910-939-5532

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

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	11/16/2023

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