=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467381574
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALLORY WOODEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2026
-----------------------------------------------------
Last Update Date | 05/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 617 GAULT AVE N
-----------------------------------------------------
City | FORT PAYNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35967-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-979-1633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4451 RODEN DR NE
-----------------------------------------------------
City | FORT PAYNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35967-7807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-996-7638
-----------------------------------------------------
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 | 1-182761
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------