Provider Demographics
NPI:1619698917
Name:SIBLEY, MALAINA PICKERING (FNP)
Entity Type:Individual
Prefix:
First Name:MALAINA
Middle Name:PICKERING
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MALAINA
Other - Middle Name:BROOKE
Other - Last Name:PICKERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 AMAR DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-1003
Mailing Address - Country:US
Mailing Address - Phone:985-351-0450
Mailing Address - Fax:
Practice Address - Street 1:1054 SW RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-3557
Practice Address - Country:US
Practice Address - Phone:985-401-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227285363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily