1144674557 NPI number — TEXAS MALONE HEALTHCARE, LLC

Table of content: MRS. KELLY A HALCOMB RPA C (NPI 1811933856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144674557 NPI number — TEXAS MALONE HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS MALONE HEALTHCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144674557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 HIGH COUNTRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75002-1840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-348-5312
Provider Business Mailing Address Fax Number:
972-727-0733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9550 FOREST LN STE 232
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-5905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-348-5312
Provider Business Practice Location Address Fax Number:
469-640-0100
Provider Enumeration Date:
04/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ONWUZURIKE
Authorized Official First Name:
IJEOMA
Authorized Official Middle Name:
Authorized Official Title or Position:
FAMILY NURSE PRACTIONER
Authorized Official Telephone Number:
469-348-5312

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 193400000X . This is a "NPPES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com