Provider Demographics
NPI:1750734356
Name:FLETCHER, MALLORI M (NP)
Entity type:Individual
Prefix:
First Name:MALLORI
Middle Name:M
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19850 OLD SCENIC HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-7384
Mailing Address - Country:US
Mailing Address - Phone:225-570-2732
Mailing Address - Fax:225-570-2652
Practice Address - Street 1:9103 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2440
Practice Address - Country:US
Practice Address - Phone:225-927-1190
Practice Address - Fax:225-927-0988
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP08798363L00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner