Individual
JESSICA JOY MALONZO SAMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1930 BISHOP LN FL 12, LOUISVILLE, KY 40218-1921
(502) 272-5220
(502) 272-5117
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3012448
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3012448
LICENSE
KY
05
—
7100589690
—
KY
01
—
71009170A
LICENSE
IN
Enumeration date
04/15/2019
Last updated
12/02/2021
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