Individual
MALLORY E BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
3 HOSPITAL DR, COLUMBIA, MO 65201-0001
(573) 882-8913
(573) 884-1070
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2022015302
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420110976
—
MO
Enumeration date
05/15/2022
Last updated
09/01/2022
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