Individual
MALLORY MIDDLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
920 OLIVER RD, MONROE, LA 71201-5702
(318) 807-6263
(318) 812-7348
Mailing address
130 DESIARD ST STE 355, MONROE, LA 71201-7363
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
206724
LA
Other
Enumeration date
07/01/2019
Last updated
01/16/2020
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