Individual
LISA MALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, CNM
Contact information
Practice address
170 N EAGLE CREEK DR STE 104, LEXINGTON, KY 40509-9087
(859) 967-5848
(859) 967-5473
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7835
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
3009349
KY
367A00000X
Advanced Practice Midwife
ARNP 2157582
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100503870
—
KY
Enumeration date
01/18/2007
Last updated
12/14/2022
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