Individual
NICOLE M. MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
863 TUNICA DR E, MARKSVILLE, LA 71351-3076
(318) 717-1175
(210) 924-4113
Mailing address
1012 PETROLEUM PKWY, BROUSSARD, LA 70518-8020
(337) 465-4600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
311571
LA
363A00000X
Physician Assistant
PA7387
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286422501
—
TX
Enumeration date
06/03/2011
Last updated
07/17/2025
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