Provider Demographics
NPI:1255902821
Name:NEAL, MALLORY A (APRN CNP)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:A
Last Name:NEAL
Suffix:
Gender:F
Credentials:APRN CNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1265 S UTICA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4243
Mailing Address - Country:US
Mailing Address - Phone:918-592-0999
Mailing Address - Fax:918-592-1021
Practice Address - Street 1:9228 S MINGO RD STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5722
Practice Address - Country:US
Practice Address - Phone:918-592-0999
Practice Address - Fax:918-592-1021
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2024-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK203738363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care