Provider Demographics
NPI:1477511228
Name:MALONE, CAROLYN MORRIS (FNP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:MORRIS
Last Name:MALONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:MCNEILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:337 W SUMMERCHASE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-2970
Mailing Address - Country:US
Mailing Address - Phone:910-223-0521
Mailing Address - Fax:910-884-9934
Practice Address - Street 1:1166 K ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2737
Practice Address - Country:US
Practice Address - Phone:706-344-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627165363LF0000X
CA95007789363LF0000X
NC5002206363LP0808X
NC005002206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health