Provider Demographics
NPI:1790221083
Name:BARNETT, MALLORY (NP-C)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:BARNETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21800 KATY FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7780
Mailing Address - Country:US
Mailing Address - Phone:713-771-1100
Mailing Address - Fax:713-771-1545
Practice Address - Street 1:21800 KATY FWY STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7780
Practice Address - Country:US
Practice Address - Phone:713-771-1100
Practice Address - Fax:713-771-1545
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132580363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH24735Medicare UPIN