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General NPI Number Information
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NPI Number | 1750757076
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Entity Type | Individual
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Provider Name | TAMMRA KAY MALLORY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 11027 BAYCREEK DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-9101
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Country | US
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Telephone | 813-730-8960
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Fax |
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Provider Business Mailing Address
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Address Line | 11027 BAYCREEK DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-9101
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Country | US
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Telephone | 813-730-8960
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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 | 71007270A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28237767A
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023038564
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 883653
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9497550
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10911
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License Number State | MN
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 40452
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License Number State | TN
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 358318
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License Number State | NY
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Taxonomy #9
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4008679
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License Number State | KY
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Taxonomy #10
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53-82580-082
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License Number State | KS
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Taxonomy #11
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 61654547
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License Number State | WA
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Taxonomy #12
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 14590-33
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License Number State | WI
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Taxonomy #13
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A176453
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License Number State | IA
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Taxonomy #14
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 116290-23
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License Number State | NH
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Taxonomy #15
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209013163
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License Number State | IL
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