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Individual
KEVIN MALICKY
Active
Individual
KEVIN MALICKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP F-NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F0214324
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102948711
—
PA
01
—
349540G0F
MEDICARE
PA
Enumeration date
02/14/2014
Last updated
03/02/2017
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