Healthcare Provider Details

I. General information

NPI: 1396786034
Provider Name (Legal Business Name): KAREN LOUISE MALLOW CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MON HEALTH DRIVE
MORGANTOWN WV
26505-2853
US

IV. Provider business mailing address

1509 DULLES DR
LAFAYETTE LA
70506-3718
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax: 337-943-0846
Mailing address:
  • Phone: 337-991-9276
  • Fax: 337-943-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024174910
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP 01828
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN99622
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: