Healthcare Provider Details

I. General information

NPI: 1629998091
Provider Name (Legal Business Name): MALLORY KLEIN
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: MALLORY BARNEY

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W MAIN ST
MANCHESTER IA
52057-1526
US

IV. Provider business mailing address

3247 130TH AVE
RYAN IA
52330-8526
US

V. Phone/Fax

Practice location:
  • Phone: 563-927-3232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA192530
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: