Individual provider Active NPI

Tasiana Malya, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Osage Beach, MO
National Provider Identifier
1396415113
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2021027654 Issued in MO
Practice address
840 Passover Rd
Osage Beach, MO 65065-2834
Phone
(573) 302-0319
Fax
(573) 693-1680
NPI assigned
Sep 14, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2006036960 MO
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2021027654 MO Primary

Addresses

Primary practice location

840 Passover Rd
Osage Beach, MO 65065-2834

Mailing address

840 Passover Rd
Osage Beach, MO 65065-2834
Phone (573) 302-0319

Other practice location 1

227 Metro Dr
Jefferson City, MO 65109-1134
Phone (844) 853-8937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230501000085 MO Practitioner - Nurse Practitioner 9032574892 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of MissouriGroup PAC ID 1456254226, 48 clinicians
Osage Beach Center for Behavioral Health, LLCGroup PAC ID 2062649288, 8 clinicians

Practice addresses (Care Compare)

600 E 5TH St
Fulton State Hospital
Fulton, MO 65251-1793
Phone (573) 592-4100

840 Passover Rd
Osage Beach, MO 65065-2834
Phone (573) 302-0319

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2006036960MOMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
State of Missouri CurrentSince Feb 1, 2026 Accepting new patients
State of Missouri CurrentSince Feb 1, 2026 Accepting new patients

Locations

600 E 5th St
Fulton, MO 65251
Phone (573) 592-2623

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1396415113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 PASSOVER RD",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650652834",
            "telephone_number": "573-302-0319",
            "fax_number": "573-693-1680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 PASSOVER RD",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650652834",
            "telephone_number": "573-302-0319",
            "fax_number": "573-693-1680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "227 Metro Dr",
            "address_purpose": "LOCATION",
            "city": "Jefferson City",
            "state": "MO",
            "postal_code": "651091134",
            "country_code": "US",
            "telephone_number": "844-853-8937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALYA",
        "first_name": "TASIANA",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-14",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2006036960",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2021027654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Osage Beach, MO

Sources for this page

Verify at the official NPI Registry.