Provider Demographics
NPI:1932416179
Name:MALONE-PRIOLEAU, OSRIC ARMAND (APRN, CRC)
Entity Type:Individual
Prefix:
First Name:OSRIC
Middle Name:ARMAND
Last Name:MALONE-PRIOLEAU
Suffix:
Gender:M
Credentials:APRN, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-1097
Mailing Address - Country:US
Mailing Address - Phone:304-699-1419
Mailing Address - Fax:304-586-6424
Practice Address - Street 1:210 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-1097
Practice Address - Country:US
Practice Address - Phone:304-699-1419
Practice Address - Fax:304-586-6424
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00105259101Y00000X
WV78679163W00000X
WV2010007619363LF0000X
WV78769363LP0808X
WV00105259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1477043552-001Medicaid
WVPENDINGMedicare PIN