Provider Demographics
NPI:1295706943
Name:MALLICOAT, HARRIET PEARSON (ARNP CNM)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:PEARSON
Last Name:MALLICOAT
Suffix:
Gender:F
Credentials:ARNP CNM
Other - Prefix:MS
Other - First Name:HATSIE
Other - Middle Name:
Other - Last Name:MALLICOAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP CNM
Mailing Address - Street 1:24417 W 114TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7333
Mailing Address - Country:US
Mailing Address - Phone:913-780-1304
Mailing Address - Fax:
Practice Address - Street 1:545 E SANTA FE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3462
Practice Address - Country:US
Practice Address - Phone:913-764-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45064363L00000X
KS64080367A00000X
MO034959363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily