Basic Information
| Provider Information | |||||||||
| NPI: | 1215607635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | MALLORY | ||||||||
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| Credential: | AGACNP-BC, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 ETTA DR | ||||||||
| Address2: | |||||||||
| City: | SAINT GABRIEL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707765624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018073760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8585 PICARDY AVE STE 313 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253812755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2021 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 221476 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2100X | 221476 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.