Healthcare Provider Details

I. General information

NPI: 1457182131
Provider Name (Legal Business Name): MALLORY LEA FRANKLIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 HIGHWAY 78 E
JASPER AL
35501-3430
US

IV. Provider business mailing address

2708 HIGHWAY 78 E
JASPER AL
35501-3430
US

V. Phone/Fax

Practice location:
  • Phone: 205-275-9791
  • Fax:
Mailing address:
  • Phone: 205-387-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-127971
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: