MEDICARE: MALLORY WOODEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-182761	AL

General Provider Information

NPI Number	:	1467381574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY WOODEN

Provider Business Mailing Address
First Line	:	4451 RODEN DR NE
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-7807
Country	:	US
Telephone Number	:	256-996-7638
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 GAULT AVE N
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-2531
Country	:	US
Telephone Number	:	256-979-1633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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Directions to “ MALLORY WOODEN ” Practice Location

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