Provider Demographics
NPI:1447876545
Name:MALONE, BRANDON SCOTT (CNP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:SCOTT
Last Name:MALONE
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-365-8681
Mailing Address - Fax:740-356-1256
Practice Address - Street 1:246 COMMONWEALTH RD
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179-5003
Practice Address - Country:US
Practice Address - Phone:606-796-0010
Practice Address - Fax:606-796-0011
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0026896363LF0000X
KY4005866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily