Provider Demographics
NPI:1194101758
Name:MALCOM, NATALIE (FNP-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MALCOM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MARGIE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7818
Mailing Address - Country:US
Mailing Address - Phone:478-971-1153
Mailing Address - Fax:478-971-1171
Practice Address - Street 1:301 MARGIE DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7818
Practice Address - Country:US
Practice Address - Phone:478-971-1153
Practice Address - Fax:478-971-1171
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily