Individual
MRS. TASIANA MALYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
840 PASSOVER RD, OSAGE BEACH, MO 65065-2834
(573) 302-0319
(573) 693-1680
Mailing address
840 PASSOVER RD, OSAGE BEACH, MO 65065-2834
(573) 302-0319
(573) 693-1680
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2006036960
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2021027654
MO
Other
Enumeration date
09/14/2021
Last updated
09/24/2024
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