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Individual
MALLORY B PUCKETT
Active
Individual
MALLORY B PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.022510
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0289079
—
OH
01
—
APRN.CNP.022510
OHELICENSE
OH
Enumeration date
03/14/2018
Last updated
02/11/2026
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