Provider Demographics
NPI:1851043947
Name:MALONE, JACOB TAFT (APRN-CNP)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:TAFT
Last Name:MALONE
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-499-4855
Mailing Address - Fax:
Practice Address - Street 1:6151 S YALE AVE STE 100A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1929
Practice Address - Country:US
Practice Address - Phone:918-494-8500
Practice Address - Fax:918-307-5578
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0109525363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care