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General NPI Number Information
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NPI Number | 1053035956
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Entity Type | Individual
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Provider Name | MALLORY KRZYS PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 12/14/2025
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Provider Practice Location Address
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Address Line | 1028 S BROADWAY
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City | GENEVA
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State | OH
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Zip | 44041-7124
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Country | US
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Telephone | 647-705-1655
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Fax |
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Provider Business Mailing Address
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Address Line | 4009 SHI MAR DR
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City | ASHTABULA
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State | OH
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Zip | 44004-4640
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Country | US
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Telephone | 440-813-1579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 50.007819RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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