Individual
MALLORY L GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
7273 HAWKINS VIEW DR, FORT WORTH, TX 76132-3921
(972) 232-7474
(972) 232-7401
Mailing address
PO BOX 261092, PLANO, TX 75026-1092
(972) 232-7474
(972) 232-7401
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP135789
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
382244702
—
TX
01
—
AP135789
LICENSE
TX
01
—
XG4602353
DATA 2000 WAIVER
TX
Enumeration date
11/15/2017
Last updated
03/07/2023
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