Provider Demographics
NPI:1841610573
Name:MALONE, JEANINE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:MARIE
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 1:2204 LEA ST
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-3230
Mailing Address - Country:US
Mailing Address - Phone:806-688-8800
Mailing Address - Fax:806-688-1176
Practice Address - Street 1:3023 PERRYTON PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2821
Practice Address - Country:US
Practice Address - Phone:806-688-8800
Practice Address - Fax:806-688-1176
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily