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General NPI Number Information
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NPI Number | 1164204913
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Entity Type | Individual
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Provider Name | MALLORY MICHELLE SWANSON DNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 2944 BRECKENRIDGE LN
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City | LOUISVILLE
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State | KY
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Zip | 40220-1409
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Country | US
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Telephone | 502-995-5525
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Fax |
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Provider Business Mailing Address
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Address Line | 5721 HARMONY WOODS
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City | MEMPHIS
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State | IN
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Zip | 47143-9283
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Country | US
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Telephone | 317-507-8696
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4010885
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License Number State | KY
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