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NPI Code Detail

MEDICARE: ANN MARIE MALLORY APRN, FNP, PMHNP

MEDICARE: ANN MARIE MALLORY APRN, FNP, PMHNP
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
1163W00000XRegistered NurseRN59162NV
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN001789NV
3363LF0000XFamily Nurse PractitionerAPRN001789NV
4363L00000XNurse PractitionerAPRN001789NV

General Provider Information

NPI Number : 1801203948
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN MARIE MALLORY APRN, FNP, PMHNP
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 : 702-608-6495
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 : 702-608-6495
Fax Number : 702-991-6412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2014
Last Update Date : 04/06/2026

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1992947535 — ADAM LUCKETTE PA-C
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