Provider Demographics
NPI:1912901406
Name:MALONE, IRIS A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:A
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 1:208 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2355
Mailing Address - Country:US
Mailing Address - Phone:337-289-2596
Mailing Address - Fax:337-289-2226
Practice Address - Street 1:501 W SAINT MARY BLVD
Practice Address - Street 2:# 416
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4600
Practice Address - Country:US
Practice Address - Phone:337-289-2596
Practice Address - Fax:337-289-2226
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1127582Medicaid
LA1127582Medicaid
LA4C502DC66Medicare PIN
LAP73975Medicare UPIN