Healthcare Provider Details

I. General information

NPI: 1700726650
Provider Name (Legal Business Name): MALLORY KAY SHERROD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 HIGHWAY 45 BYP STE 105
JACKSON TN
38305-0601
US

IV. Provider business mailing address

3021 HIGHWAY 45 BYP STE 105
JACKSON TN
38305-0601
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-4600
  • Fax:
Mailing address:
  • Phone: 731-300-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number41640
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: