Individual
MALLORY LEEANN BROADAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
1704 HIGHWAY 69 WEST, TRUMANN, AR 72472-2029
(870) 483-4003
(870) 483-4009
Mailing address
1815 PLEASANT GROVE ROAD, JONESBORO, AR 72401-7870
(870) 933-6886
(870) 933-9395
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
A003980
AR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
A003980
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201676758
—
AR
01
—
5PA17
BCBS
AR
Enumeration date
11/08/2013
Last updated
05/03/2021
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