Individual
ETHAN DAVIS MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
3201 MCCLELLAND BLVD, SUITE B, JOPLIN, MO 64804
(417) 347-6625
Mailing address
3708 CHELSEA, WEBB CITY, MO 64870-9572
(417) 483-2014
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2025036708
MO
Other
Enumeration date
10/27/2025
Last updated
10/27/2025
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