Healthcare Provider Details

I. General information

NPI: 1013596873
Provider Name (Legal Business Name): ALEXIS M MALLETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HIGHWAY 62 65 N STE 220
HARRISON AR
72601-1702
US

IV. Provider business mailing address

PO BOX 2990
HARRISON AR
72602-2990
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-6418
  • Fax: 870-741-5071
Mailing address:
  • Phone: 870-741-6418
  • Fax: 870-741-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE20496
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: