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General NPI Number Information
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NPI Number | 1932859774
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Entity Type | Individual
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Provider Name | MALLORY BROOKE NICHOLS FNP-C, CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 809 UNIVERSITY BLVD E
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City | TUSCALOOSA
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State | AL
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Zip | 35401-2071
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Country | US
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Telephone | 205-759-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 676 HEIBERGER LOOP
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City | MARION
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State | AL
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Zip | 36756-6525
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Country | US
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Telephone | 205-394-9150
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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 | 1-144817
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License Number State | AL
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