Healthcare Provider Details

I. General information

NPI: 1801203948
Provider Name (Legal Business Name): ANN MARIE MALLORY APRN, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN MARIE WARREN FNP-BC

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 02/02/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 S DECATUR BLVD STE B6
LAS VEGAS NV
89103-6802
US

IV. Provider business mailing address

2620 REGATTA DR STE 102
LAS VEGAS NV
89128-6892
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-2100
  • Fax:
Mailing address:
  • Phone: 702-608-6495
  • Fax: 702-991-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN59162
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN001789
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001789
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN001789
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: