Healthcare Provider Details

I. General information

NPI: 1417428111
Provider Name (Legal Business Name): MALLORY ELIZABETH SESSIONS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORY ELIZABETH POWERS

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-6870
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22448
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: