Individual
MRS. MALLORY DAYLE WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP-FAMILY
Contact information
Practice address
514 PLAZA CT, SAND SPRINGS, OK 74063-7915
(918) 215-5100
(918) 215-5105
Mailing address
514 PLAZA CT, SAND SPRINGS, OK 74063-7915
(918) 215-5100
(918) 215-5105
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
92345
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200599040A
—
OK
01
—
434557YMSD
MEDICARE
OK
Enumeration date
03/06/2015
Last updated
02/12/2019
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