Healthcare Provider Details

I. General information

NPI: 1528508793
Provider Name (Legal Business Name): MALLORY PATTERSON MSN, RN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WOODSON ST
SALISBURY NC
28144-3255
US

IV. Provider business mailing address

1005 SPRING ROCK DR
SALISBURY NC
28146-9456
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-5576
  • Fax:
Mailing address:
  • Phone: 704-754-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5009349
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number5009349
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: