Individual
MALLORIE WEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
106 MAGNOLIA DR STE 200, GEORGETOWN, KY 40324-8129
(502) 868-0806
Mailing address
106 MAGNOLIA DR STE 200, GEORGETOWN, KY 40324-8129
(502) 868-0806
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3019084
KY
363LF0000X
Family Nurse Practitioner
3019084
KY
363LP2300X
Primary Care Nurse Practitioner
3019084
KY
Other
Enumeration date
05/01/2023
Last updated
05/25/2023
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