Malcom, Lacondra

Malcom, Lacondra is an individual health care provider with primary practice located at 4502 Vega St , Pascagoula MS 39581-5305. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Malcom, Lacondra can be contacted via phone (228) 696-9224.

Contact Information

Primary practice address
4502 Vega St Pascagoula MS 39581-5305
Phone: (228) 696-9224
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X R869844 Mississippi

Profile Details

NPI number 1487012043
LBN Legal business name Malcom, Lacondra
Credentials PMHNP
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 10th, 2016
Last updated Apr 27th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487012043 NPPES
Mississippi MEDICAID 04307541

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