Individual
KATHERINE E MALLION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, CNP
Contact information
Practice address
1511 S GRAND AVE, ROSWELL, NM 88203-5407
(575) 623-3255
(575) 625-9901
Mailing address
1515 W FIR ST, PORTALES, NM 88130-5703
(575) 356-6695
(575) 356-5948
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
94PA26
NM
363LW0102X
Women's Health Nurse Practitioner
CNP00188
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91544
—
NM
Enumeration date
11/02/2005
Last updated
06/22/2015
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