MEDICARE: ANN MARIE MALLORY APRN, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1609687656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN MARIE MALLORY APRN, PLLC

Provider Business Mailing Address
First Line	:	2400 N TENAYA WAY STE 114
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0644
Country	:	US
Telephone Number	:	702-648-6495
Fax Number	:	702-991-6412

Provider Business Practice Location Address
First Line	:	2400 N TENAYA WAY STE 114
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0644
Country	:	US
Telephone Number	:	702-648-6495
Fax Number	:	702-991-6412

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	ANN MARIE MALLORY
Credential	:	NP
Telephone Number	:	702-608-6495

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	04/06/2026

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