Provider Demographics
NPI:1730689696
Name:MALONE, NATASHA MICHELL (RN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:MICHELL
Last Name:MALONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:MICHELL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:405 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-2323
Mailing Address - Country:US
Mailing Address - Phone:936-240-1794
Mailing Address - Fax:
Practice Address - Street 1:4932 STATE HIGHWAY 87 N
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-5215
Practice Address - Country:US
Practice Address - Phone:936-240-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305342164X00000X
TX1015138163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse