Provider Demographics
NPI:1003332834
Name:CUMMINGS, MALLORY ERIN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ERIN
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:MALLORY
Other - Middle Name:ERIN
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1125
Mailing Address - Country:US
Mailing Address - Phone:804-798-8307
Mailing Address - Fax:804-798-4204
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1125
Practice Address - Country:US
Practice Address - Phone:804-798-8307
Practice Address - Fax:804-798-4204
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175232363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05704OtherMEDICARE PTAN