Individual
BRANDI MICHELE MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACAGNP
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 593-8441
Mailing address
PO BOX 1120, FRANKSTON, TX 75763-1120
(903) 570-0596
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
AP138255
TX
363L00000X
Nurse Practitioner
Primary
AP138255
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1G0062
MEDICARE
TX
01
—
1G8783
MEDICARE
TX
05
—
407522802
—
TX
05
—
407522803
—
TX
Enumeration date
08/22/2018
Last updated
06/05/2024
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