Individual
MRS. AMY J MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1300 N 4TH ST, LONGVIEW, TX 75601-4717
(903) 757-6042
(903) 758-1801
Mailing address
PO BOX 911230, DALLAS, TX 75390-1230
(972) 997-8000
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA0124
TX
363AS0400X
Surgical Physician Assistant
Primary
PA01024
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204712803
—
TX
05
—
204712805
—
TX
05
—
361638502
—
TX
Enumeration date
07/28/2005
Last updated
07/28/2021
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