MEDICARE: TAMMRA KAY MALLORY FNP-C

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	363LF0000X	Family Nurse Practitioner	71007270A	IN
2	363LF0000X	Family Nurse Practitioner	28237767A	OH
3	363LF0000X	Family Nurse Practitioner	2023038564	MO
4	363LF0000X	Family Nurse Practitioner	883653	NV
5	363LF0000X	Family Nurse Practitioner	APRN9497550	FL
6	363LF0000X	Family Nurse Practitioner	10911	MN
7	363LF0000X	Family Nurse Practitioner	40452	TN
8	363LF0000X	Family Nurse Practitioner	358318	NY
9	363LF0000X	Family Nurse Practitioner	4008679	KY
10	363LF0000X	Family Nurse Practitioner	53-82580-082	KS
11	363LF0000X	Family Nurse Practitioner	61654547	WA
12	363LF0000X	Family Nurse Practitioner	14590-33	WI
13	363LF0000X	Family Nurse Practitioner	A176453	IA
14	363LF0000X	Family Nurse Practitioner	116290-23	NH
15	363LF0000X	Family Nurse Practitioner	209013163	IL

General Provider Information

NPI Number	:	1750757076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMRA KAY MALLORY FNP-C

Provider Business Mailing Address
First Line	:	11027 BAYCREEK DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-9101
Country	:	US
Telephone Number	:	813-730-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	11027 BAYCREEK DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-9101
Country	:	US
Telephone Number	:	813-730-8960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	12/03/2025

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