Provider Demographics
NPI:1275351009
Name:MALONE, DYSYAN (PMHNP)
Entity type:Individual
Prefix:
First Name:DYSYAN
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 PRIMAVERA LN
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5446
Mailing Address - Country:US
Mailing Address - Phone:719-460-4571
Mailing Address - Fax:
Practice Address - Street 1:2121 E COUNTY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-9064
Practice Address - Country:US
Practice Address - Phone:573-875-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024039932363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health