Kristi Lynn Malicoat, LPN
Individual provider Active NPI Licensed Practical Nurse · Grand View, ID
NPI 1013232834 · NPPES record last updated May 9, 2011
Key facts
- NPI
- 1013232834
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- PN-12009 (ID)
- Practice address
- 23220 River Rd
Grand View, ID 83624-5009 - Phone
- (208) 834-2860
- NPI assigned
- Apr 5, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN-12009 | ID | MD | Licensed Practical Nurse |
| 27036628A | IN | MD | Licensed Practical Nurse |
| LPN11423 | NV | MD | Licensed Practical Nurse |
| 200930022LPN | OR | MD | Licensed Practical Nurse |
| VN249377 | CA | MD | Licensed Vocational Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 200930022LPN | OR | |
| Licensed Practical Nurse | 164W00000X | PN-12009 | ID | Yes |
| Licensed Practical Nurse | 164W00000X | 27036628A | IN | |
| Licensed Practical Nurse | 164W00000X | LPN11423 | NV | |
| Licensed Vocational Nurse | 164X00000X | VN249377 | CA |
Addresses
Primary practice location
23220 River Rd
Grand View, ID 83624-5009
Mailing address
PO Box 632
Grand View, ID 83624-0632
Phone (208) 834-2860
Other providers in Grand View, ID
- Bruneau-Grand View JT. School District #365
- Glenns Ferry Health Center, Inc.
- Grand View Ambulance-Rimrock Search and Rescue, Inc.
- Sierra Palmer
- Terrence Schwartz
All providers in Grand View, ID · Licensed Practical Nurse in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.