Provider Demographics
NPI:1598653685
Name:NEWLON, MALLORY BROOKE
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:BROOKE
Last Name:NEWLON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8247 ELK AVE
Mailing Address - Street 2:
Mailing Address - City:STONEWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26301-8019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8247 ELK AVE
Practice Address - Street 2:
Practice Address - City:STONEWOOD
Practice Address - State:WV
Practice Address - Zip Code:26301-8019
Practice Address - Country:US
Practice Address - Phone:304-918-4553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide