Provider Demographics
NPI:1891257903
Name:MALLAN, KAVITHAMANI (FNP)
Entity Type:Individual
Prefix:
First Name:KAVITHAMANI
Middle Name:
Last Name:MALLAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 BEGEN ST
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9769
Mailing Address - Country:US
Mailing Address - Phone:424-757-3022
Mailing Address - Fax:
Practice Address - Street 1:249 E HWY 54
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27113
Practice Address - Country:US
Practice Address - Phone:919-907-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF01191504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily