=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336340611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CALYN ASHLEY MALLOY RN, MSN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 210161
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36121-0161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-799-7829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2758 S 700 W
-----------------------------------------------------
City | NEW PALESTINE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46163-8989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-861-5237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F0117802
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------