Provider Demographics
NPI:1841777810
Name:WELBORN, MALLORY CHRISTINE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:CHRISTINE
Last Name:WELBORN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 SAINT JAMES WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1761
Mailing Address - Country:US
Mailing Address - Phone:270-754-3494
Mailing Address - Fax:
Practice Address - Street 1:222 PHILLIP STONE WAY
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1929
Practice Address - Country:US
Practice Address - Phone:270-754-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily