Provider Demographics
NPI:1457730715
Name:MALLETT, RACHEL (RN, FNP-BC, MSN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MALLETT
Suffix:
Gender:F
Credentials:RN, FNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E BROADWAY STE 260
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8041
Mailing Address - Country:US
Mailing Address - Phone:573-815-2221
Mailing Address - Fax:573-815-5320
Practice Address - Street 1:1601 E BROADWAY STE 260
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8041
Practice Address - Country:US
Practice Address - Phone:573-815-2221
Practice Address - Fax:573-815-5320
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015015185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily