Individual
LACONDRA MALCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
4502 VEGA ST, PASCAGOULA, MS 39581-5305
(228) 696-9224
Mailing address
4502 LT EUGENE J MAJURE DR, PASCAGOULA, MS 39581-5305
(228) 696-9224
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R869844
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04307541
—
MS
Enumeration date
02/10/2016
Last updated
04/27/2020
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