Individual
KAWANNA CORRINE MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.F.N.P.
Contact information
Practice address
1495 MAPLE RD, NETTLETON, MS 38858-6026
(662) 963-9146
(662) 963-9186
Mailing address
361 CR 122, NETTLETON, MS 38858-6026
(662) 825-1086
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R682403
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05774270
—
MS
Enumeration date
09/22/2006
Last updated
03/20/2014
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