Provider Demographics
NPI:1891231007
Name:YOUNG, MALLORY NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:1212 CORPORATE DR STE 470
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 MEDICAL PARK LN STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4902
Practice Address - Country:US
Practice Address - Phone:877-377-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2023-10-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant