Individual
MRS. MALLORY ELYSE MOWDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
724 N JACKSON ST, BROOKHAVEN, MS 39601-2460
(601) 833-5255
(601) 843-0252
Mailing address
724 N JACKSON ST, BROOKHAVEN, MS 39601-2460
(601) 833-5255
(601) 843-0252
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R877141
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02337065
—
MS
01
—
1427458553
BLUE CROSS BLUE SHIELD
MS
Enumeration date
08/26/2014
Last updated
01/23/2023
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