Provider Demographics
NPI:1639417215
Name:CARROLL, MALLORY MATHIS (PNP, FNP, MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:MATHIS
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PNP, FNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1600 7TH AVE S # CPPNM20
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1711
Mailing Address - Country:US
Mailing Address - Phone:205-638-9072
Mailing Address - Fax:205-638-2833
Practice Address - Street 1:1600 7TH AVE S # CPPNM20
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-9072
Practice Address - Fax:205-638-2833
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-185381363LP0200X
GARN198991363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics