# JORDAN MALONE PMHNP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740852730
- **Authorized official:** JORDAN LEIGH MALONE APRN (PSYCHIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (314) 766-7290

## Contact information

- **Practice address:** 11477 OLDE CABIN RD STE 210, CREVE COEUR, MO 63141-7129
- **Practice address phone:** (314) 997-5208
- **Practice address fax:** (314) 997-5368
- **Mailing address:** 11477 OLDE CABIN RD STE 210, CREVE COEUR, MO 63141-7129
- **Mailing address phone:** (314) 997-5208
- **Mailing address fax:** (314) 997-5368

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/11/2021
- **Last updated:** 07/11/2021