MS. MALLORY JOHNSON (NPI# 1265699508) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265699508 |
| Entity Type | Individual |
| Full Name | MS. MALLORY JOHNSON |
| Other Name | MALLORY BRAUN |
| Credential | PEDIATRIC NP |
| Practice Address |
11790 Sw Barnes Rd. Blg A Ste 140 Portland OR 97225 |
| Practice Telephone | 5036432100 |
| Practice Fax Number | 5036437300 |
| Mailing Telephone | 5036432100 |
| Mailing Fax Number | 5036437300 |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2016-04-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
200850163NP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972110815 | Mallory Quinn Johnson | Registered Nurse | 449 Kelso Trl, Corbin, KY 40701-8502 | 2020-09-24 |
| 1235456815 | Mallory K Johnson | Speech-Language Pathologist | 4423 Colomba St, Houston, TX 77045-3523 | 2010-04-22 |
| 1366081473 | Mallory Claire Johnson | Behavioral Analyst | 225 Cedar Hill St Ste 200, Marlborough, MA 01752-5900 | 2020-01-06 |
| 1093366338 | Mallory Johnson | Counselor | 11103 Park Rd, Louisville, KY 40223-2424 | 2019-09-27 |
| 1518520238 | Mallory Brooke Johnson | Nurse Practitioner | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2019-04-18 |
| 1407349434 | Mallory Johnson | Counselor | 3322 Broadway Fl 4, Everett, WA 98201-4425 | 2018-06-13 |
| 1790100600 | Mallory Johnson | Counselor | 1921 Ransom Pl, Nashville, TN 37217-3841 | 2014-02-28 |
| 1992034144 | Mallory Marie Johnson | Massage Therapist | 670 Nw Gilman Blvd, Suite #b2, Issaquah, WA 98027-2444 | 2009-12-17 |
| Street Address |
11790 SW BARNES RD. BLG A STE 140 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508425034 | Gabrielle Gonzales | Behavior Technician | 1675 Sw Marlow Ave, Suite 200, Portland, OR 97225 | 2019-06-08 |
| 1558844555 | Tate Roseberry | Behavior Technician | 1675 Sw Marlow Avenue, Suite 200, Portland, OR 97225 | 2018-09-14 |
| 1982186300 | Dean Alan Hopkins | Registered Nurse | 11782 Sw Barnes Rd, Suite 300, Portland, OR 97225 | 2018-09-01 |
| 1316449168 | Surgery Center At St. Vincent, LLC | Clinic/Center | 9135 Sw Barnes Rd Ste 161, Portland, OR 97225 | 2018-03-07 |
| 1730606716 | Meghan Louise Lacy | Pediatrics | 11790 Sw Barnes Rd, Blg. A, Suite 140, Portland, OR 97225 | 2017-08-29 |
| 1841733433 | Tia Pugh | Occupational Therapist | 9155 S.w. Barnes Road, East Pavilion, Portland, OR 97225 | 2016-11-30 |
| 1295185585 | Stephanie Lynn Hart | Nurse Practitioner | 9155 Sw Barnes Rd Ste 240, Portland, OR 97225 | 2016-06-16 |
| 1962866244 | Bejian Shamloo | Chiropractor | 10200 Sw Eastridge St., Suite 235, Portland, OR 97225 | 2016-04-12 |
| 1992162630 | Robert Joseph Yoder | Psychologist | 9045 Barnes Rd, Portland, OR 97225 | 2016-01-26 |
| 1316303951 | Katie Herold | Chiropractor | 9315 Sw Morrison St, Portland, OR 97225 | 2016-01-12 |
| Find all providers in zip 97225 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477197705 | Kelsey-jo Audrey Moss | Nurse Practitioner | 704b Ne 62nd Ave, Portland, OR 97213-4351 | 2019-10-30 |
| 1063054716 | Lori P Balchik | Nurse Practitioner | 277 Buddy Ganem Dr Ste A, Portland, TX 78374-3202 | 2019-10-15 |
| 1295273399 | Shaudine Woody | Nurse Practitioner | 11790 Sw Barnes Rd Ste 140, Portland, OR 97225-5938 | 2017-02-08 |
| 1003239120 | Iva Juric | Nurse Practitioner | 3181 Sw Sam Jackson Park Rd # Cdw6, Portland, OR 97239-3011 | 2014-01-24 |
| 1811249592 | Pollee Hruby Brookings | Nurse Practitioner | 3181 Sw Sam Jackson Park Rd # Cdw7, Portland, OR 97239-3098 | 2012-10-05 |
| 1033470646 | Chelsea Doherty | Nurse Practitioner | 14480 Sw 90th Ave, Portland, OR 97224 | 2012-05-31 |
| 1053320804 | Karen Elizabeth Caines | Nurse Practitioner | 96 Falmouth St, Portland, ME 04104-9300 | 2006-08-07 |
| 1649209982 | Joanne M Perry | Nurse Practitioner | 901 Washington Ave Ste 100, Portland, ME 04103-2842 | 2006-06-30 |
| 1497377220 | Erika Lynn Rodakowski | Nurse Practitioner | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2020-05-14 |
| 1518502160 | Brandy Lynn Crowson | Nurse Practitioner | 277 Buddy Ganem Dr Ste A, Portland, TX 78374-3202 | 2019-11-07 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.