Provider Demographics
NPI:1700499241
Name:JONES, MALLORY (CFNP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516B LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2226
Mailing Address - Country:US
Mailing Address - Phone:662-243-0008
Mailing Address - Fax:662-570-4264
Practice Address - Street 1:516B LINCOLN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2226
Practice Address - Country:US
Practice Address - Phone:662-243-0008
Practice Address - Fax:662-570-4264
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904088363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care