Healthcare Provider Details

I. General information

NPI: 1083447791
Provider Name (Legal Business Name): MALORIE RUTH CORTEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 24TH ST
LUBBOCK TX
79410-1894
US

IV. Provider business mailing address

5012 57TH ST
LUBBOCK TX
79414-4126
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-0000
  • Fax:
Mailing address:
  • Phone: 806-778-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1166379
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1166379
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: