Provider Demographics
NPI:1417173139
Name:MALONE, KELLY KAY (ANP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KAY
Last Name:MALONE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
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Mailing Address - Street 1:1 MEDICAL DR
Mailing Address - Street 2:STE 603
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4017
Mailing Address - Country:US
Mailing Address - Phone:870-236-2202
Mailing Address - Fax:870-236-8428
Practice Address - Street 1:1 MEDICAL DR
Practice Address - Street 2:STE 603
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4017
Practice Address - Country:US
Practice Address - Phone:870-236-2202
Practice Address - Fax:870-236-8428
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA02931 ANP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner