Provider Demographics
NPI:1366254054
Name:MALONE, STACY MARIE
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE
Last Name:MALONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 L AVENUE PL
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-7205
Mailing Address - Country:US
Mailing Address - Phone:402-621-0536
Mailing Address - Fax:
Practice Address - Street 1:6308 L AVENUE PL
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-7205
Practice Address - Country:US
Practice Address - Phone:402-621-0536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24554164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse