Healthcare Provider Details

I. General information

NPI: 1912377052
Provider Name (Legal Business Name): MALLORY HANNON KELLEHER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BILTMORE AVE
ASHEVILLE NC
28801-4601
US

IV. Provider business mailing address

50 SCHENCK PKWY
ASHEVILLE NC
28803-3499
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-2325
  • Fax:
Mailing address:
  • Phone: 828-681-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number282948
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: