Provider Demographics
NPI:1063646487
Name:MALONE, TONYA POWELL (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:POWELL
Last Name:MALONE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 KATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8801
Mailing Address - Country:US
Mailing Address - Phone:601-420-3223
Mailing Address - Fax:601-420-3054
Practice Address - Street 1:266 KATHERINE DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8801
Practice Address - Country:US
Practice Address - Phone:601-420-3223
Practice Address - Fax:601-420-3054
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR862448163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
W081643OtherCNOR CERTIFICATION
R862448OtherRN LICENSE