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General NPI Number Information
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NPI Number | 1467215285
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Entity Type | Individual
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Provider Name | MALLORY WELTER SCELFO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 206 WANDERLUST CT
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City | JOHNSON CITY
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State | TN
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Zip | 37604-3248
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Country | US
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Telephone | 228-860-7831
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Fax |
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Provider Business Mailing Address
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Address Line | 206 WANDERLUST CT
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City | JOHNSON CITY
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State | TN
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Zip | 37604-3248
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Country | US
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Telephone | 228-860-7831
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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 | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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