Active NPI
Gwen Bonita Malone, CRNP
- Nurse Practitioner
- Tuscaloosa, AL
National Provider Identifier
1720184781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1044329
- Practice address
- 200 University Blvd
Tuscaloosa, AL 35402-0707 - Phone
- (205) 759-0633
- Fax
- (205) 759-0635
- NPI assigned
- Sep 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1044329 | AL | Primary |
Addresses
Primary practice location
200 University Blvd
Tuscaloosa, AL 35402-0707
Mailing address
PO Box 21231
200 University Blvd
Tuscaloosa, AL 35402-0707
Phone (205) 759-0633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1044329 | AL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Alabama Dept of Finance | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychiatric Hospital
- Tuscaloosa, AL
- NPI 1033213624
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720184781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 21231",
"address_2": "200 UNIVERSITY BLVD",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354020707",
"telephone_number": "205-759-0633",
"fax_number": "205-759-0635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 UNIVERSITY BLVD",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354020707",
"telephone_number": "205-759-0633",
"fax_number": "205-759-0635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALONE",
"first_name": "GWEN",
"middle_name": "BONITA",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AL",
"license": "1044329",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tuscaloosa, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.