Provider Demographics
NPI:1033718465
Name:DOYLE, MALLORY ANN (AGPCNP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:ANN
Last Name:DOYLE
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9309 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2673
Mailing Address - Country:US
Mailing Address - Phone:989-980-4797
Mailing Address - Fax:
Practice Address - Street 1:105 FINANCIAL PL
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8437
Practice Address - Country:US
Practice Address - Phone:270-765-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015251207RN0300X
VA0024183595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology