Provider Demographics
NPI:1649707068
Name:MALONE, ALYSSA J (FNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:J
Last Name:MALONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:470 BENNETT DR STE B
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792-9273
Practice Address - Country:US
Practice Address - Phone:260-375-3670
Practice Address - Fax:260-375-3669
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007366A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner