Individual
MALLORY JEAN LACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1620 PRESIDENT AVE, FALL RIVER, MA 02720-7148
(508) 672-2403
Mailing address
546 SOUTH ST E, RAYNHAM, MA 02767-1079
(508) 821-5700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2352059
MA
363LF0000X
Family Nurse Practitioner
Primary
RN2352059
MA
Other
Enumeration date
02/20/2025
Last updated
05/07/2026
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