Broadaway, Mallory Leeann

Broadaway, Mallory Leeann is an individual health care provider with primary practice located at 1704 Highway 69 West , Trumann AR 72472-2029. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Broadaway, Mallory Leeann can be contacted via phone (870) 483-4003.

Contact Information

Primary practice address
1704 Highway 69 West Trumann AR 72472-2029
Phone: (870) 483-4003
Fax: (870) 483-4009
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X A003980 Arkansas
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X A003980 Arkansas

Profile Details

NPI number 1881023828
LBN Legal business name Broadaway, Mallory Leeann
Credentials APRN-CNP
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 8th, 2013
Last updated May 3rd, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881023828 NPPES
Arkansas MEDICAID 201676758
Arkansas Other 5PA17

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