National Provider Identifier Database

MALLORY L BROADAWAY, APRN-CNP – NPI #1881023828
Psychiatric/Mental Health


Contact Information

MALLORY L BROADAWAY, APRN-CNP
1704 HIGHWAY 69 WEST
TRUMANN, AR72472-2029
Phone: 870-483-4003
Fax: 870-483-4009
Website:
Specialty Taxonomy Code
* Psychiatric/Mental Health 363LP0808X
Family 363LF0000X

* Indicates primary specialty

NPI Profile & details for MALLORY L BROADAWAY

NPI Number 1881023828
Credentials APRN-CNP
Entity Individual
Enumeration date 11/08/2013
Last updated 05/03/2021 - About 5 years ago
Sole proprietor1 No
Identifiers
  • AR License #: A003980
  • AR Medicaid: 201676758
  • AR Other: 5PA17 BCBS
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for MALLORY L BROADAWAY, APRN-CNP

There are currently no reviews for MALLORY L BROADAWAY, APRN-CNP


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