Provider Demographics
NPI:1609203322
Name:MALCOLM, AMBER MARIE (ACNP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:MARIE
Last Name:MALCOLM
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Gender:F
Credentials:ACNP
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-1408
Mailing Address - Fax:314-362-3752
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV NEUROLOGY NEUROMUSCULAR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-1408
Practice Address - Fax:314-362-3752
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2024-04-10
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Provider Licenses
StateLicense IDTaxonomies
MO2013041173363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420010374Medicaid