Individual
OLGA MALLICOAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1082 SHADOW WOOD LN, MORRISTOWN, TN 37814-8010
(423) 312-0864
Mailing address
1082 SHADOW WOOD LN, MORRISTOWN, TN 37814-8010
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
23052
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23052
APRN LICENSE NUMBER
TN
Enumeration date
08/22/2017
Last updated
06/16/2018
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