Mallory, Lisa R

Mallory, Lisa R is an individual health care provider with primary practice located at 506 Chestnut St , South Charleston WV 25309-1204. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Mallory, Lisa R can be contacted via phone (304) 766-8558.

Contact Information

Primary practice address
506 Chestnut St South Charleston WV 25309-1204
Phone: (304) 766-8558
Fax: (304) 766-8561
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X APRN741400AGPCNP-BC West Virginia
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X APRN74140-AGPCNP-BC West Virginia

Profile Details

NPI number 1598223216
LBN Legal business name Mallory, Lisa R
Credentials AGNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 12th, 2019
Last updated Jan 7th, 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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