Provider Demographics
NPI:1518259480
Name:MALIYEKKAL, LINCY A (FNP)
Entity type:Individual
Prefix:
First Name:LINCY
Middle Name:A
Last Name:MALIYEKKAL
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 1:500 OLD RIVER RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9504
Mailing Address - Country:US
Mailing Address - Phone:661-664-1230
Mailing Address - Fax:661-663-3008
Practice Address - Street 1:500 OLD RIVER RD
Practice Address - Street 2:SUITE 155
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9504
Practice Address - Country:US
Practice Address - Phone:661-664-1230
Practice Address - Fax:661-716-5484
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily