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General NPI Number Information
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NPI Number | 1215607635
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Entity Type | Individual
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Provider Name | MALLORY PRICE AGACNP-BC, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 8585 PICARDY AVE STE 313
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City | BATON ROUGE
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State | LA
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Zip | 70809-3749
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Country | US
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Telephone | 225-381-2755
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 ETTA DR
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City | SAINT GABRIEL
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State | LA
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Zip | 70776-5624
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Country | US
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Telephone | 601-807-3760
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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 | 221476
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 221476
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License Number State | LA
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