Provider Demographics
NPI:1033868963
Name:TRAYER, MALLORY MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:MICHELLE
Last Name:TRAYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 BOISE LN
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3906
Mailing Address - Country:US
Mailing Address - Phone:304-279-4789
Mailing Address - Fax:
Practice Address - Street 1:2761 JEFFERSON DAVIS HWY STE 201
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8329
Practice Address - Country:US
Practice Address - Phone:540-390-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily