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General NPI Number Information
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NPI Number | 1831180405
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Entity Type | Individual
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Provider Name | KATHERINE E MALLION PA-C, CNP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 1511 S GRAND AVE
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City | ROSWELL
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State | NM
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Zip | 88203-5407
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Country | US
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Telephone | 575-623-3255
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Fax | 575-625-9901
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Provider Business Mailing Address
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Address Line | 1515 W FIR ST
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City | PORTALES
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State | NM
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Zip | 88130-5703
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Country | US
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Telephone | 575-356-6695
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Fax | 575-356-5948
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 94PA26
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | CNP00188
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License Number State | NM
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