Individual
MALLORY BROOKE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
125 QUEENS RD STE 610, CHARLOTTE, NC 28204-3580
(980) 302-6600
(980) 302-6605
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(980) 302-6600
(980) 302-6605
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5011691
NC
363LF0000X
Family Nurse Practitioner
5011691
NC
Other
Enumeration date
04/18/2019
Last updated
06/25/2024
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