Healthcare Provider Details

I. General information

NPI: 1679903298
Provider Name (Legal Business Name): MALLORY LEANNE POPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 08/14/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S MANUFACTURERS ROW, TRENTON TN
TRENTON TN
38382
US

IV. Provider business mailing address

1250 S MANUFACTURERS ROW, TRENTON TN
TRENTON TN
38382
US

V. Phone/Fax

Practice location:
  • Phone: 731-855-7601
  • Fax:
Mailing address:
  • Phone: 731-855-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2662
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: