Provider Demographics
NPI:1588034425
Name:MALONE, SAMERRIAL (FNP)
Entity Type:Individual
Prefix:
First Name:SAMERRIAL
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 HOSPITAL DR.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2399
Mailing Address - Country:US
Mailing Address - Phone:318-212-7960
Mailing Address - Fax:318-212-7965
Practice Address - Street 1:2449 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1910
Practice Address - Country:US
Practice Address - Phone:318-212-7960
Practice Address - Fax:318-212-7965
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08415363LF0000X
TXAP128795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily