Basic Information
| Provider Information | |||||||||
| NPI: | 1336104942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALONEY | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | A.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2006 FRANKLIN ST SE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565399471 | ||||||||
| FaxNumber: | 2565399472 | ||||||||
| Practice Location | |||||||||
| Address1: | 6720 BERTNER AVE STE O-520 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323552666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 06/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | 235 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant | 367H00000X | AA827 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
ID Information
| ID | Type | State | Issuer | Description | 051556376 | 05 | AL | MEDICAID | 4113999 | 01 | TN | BCBS- TN | OTHER | 051529674 | 01 | AL | BCBS- AL | OTHER |