Individual
MALLORY LYNN GOODALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2796
(682) 885-6400
Mailing address
9900 CHAPARRAL PASS, FORT WORTH, TX 76126-2168
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
880643
TX
Other
Enumeration date
10/21/2024
Last updated
10/21/2024
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