Provider Demographics
NPI:1922515576
Name:COWAN, MALLORY ELISE (AGACNP-BC,FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ELISE
Last Name:COWAN
Suffix:
Gender:F
Credentials:AGACNP-BC,FNP-C
Other - Prefix:MS
Other - First Name:MALLORY
Other - Middle Name:ELISE
Other - Last Name:LIGHTFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC,FNP-C
Mailing Address - Street 1:7600 KIRBY DR APT 555
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4481
Mailing Address - Country:US
Mailing Address - Phone:901-503-7913
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-704-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX850960363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily