MALLORY LEEANN BROADAWAY


Address: 1200 James Street, Jacksonville, AR 72076-3143
Phone: 5019825000

MALLORY LEEANN BROADAWAY (NPI# 1881023828) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1881023828
Entity Type Individual
Full Name MALLORY LEEANN BROADAWAY
Credential CNS
Practice Address 1200 James Street
Jacksonville
AR 72076-3143
Mailing Address 1815 Pleasant Grove Road
Jonesboro
AR 72401-7870
Practice Telephone 5019825000
Practice Fax Number 5019825007
Mailing Telephone 8709336886
Mailing Fax Number 8709339395
Enumeration Date 2013-11-08
Last Update Date 2016-06-07
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363LF0000X Nurse Practitioner
Specialization: Family
A003980 AR Physician Assistants & Advanced Practice Nursing Providers
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
A003980 AR Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
AR 201676758 05
AR BCBS 5PA17 01

Office Location

Street Address 1200 JAMES STREET
City JACKSONVILLE
State AR
Zip Code 72076-3143

Providers in the same location

NPI Name Taxonomy Address Enumeration
1710016662 Melanie L Cook-dobbins Social Worker 1200 James Street, Jacksonville, AR 72076-3143 2007-03-05
1750763678 Justin Wade Keathley Counselor 1200 James Street, Jacksonville, AR 72076 2015-06-27
1942681895 Teresa Nadine Hardy Case Manager/Care Coordinator 1200 James Street, Jacksonville, AR 72076 2015-06-17
1932597168 James Kenneth Burnett Case Manager/Care Coordinator 1200 James Street, Jacksonville, AR 72076 2014-12-22
1902215221 Megan Leann Loney Case Manager/Care Coordinator 1200 James Street, Jacksonville, AR 72076 2014-08-12
1972926855 Shana Lynn Genenbacher Case Manager/Care Coordinator 1200 James Street, Jacksonville, AR 72076 2014-01-28
1609297696 Brandi Nicole Baker Case Manager/Care Coordinator 1200 James Street, Jacksonville, AR 72076 2013-12-18
1245667237 Mark Howard Kelso Counselor 1200 James Street, Jacksonville, AR 72076 2013-10-04
1932547940 Elizabeth Seidita Case Manager/Care Coordinator 1200 James Street, Jacksonville, AR 72076 2013-06-12
1083057566 Tara A Smith Counselor 1200 James Street, Jacksonville, AR 72076 2013-04-15
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1598396046 Jennifer Michelle Price Licensed Practical Nurse 2400 West Main, Jacksonville, AR 72076 2020-02-03
1912464009 Stat Home Health - Cenark LLC Home Health 1410 Braden Street, Jacksonville, AR 72076 2019-02-25
1649797671 Caring Hearts Counseling, LLC Case Management 111 Marble Drive, Jacksonville, AR 72076 2017-08-30
1376071340 Anne Elizabeth Houtchens Speech-Language Pathologist 2701 Tp White Drive, Jacksonville, AR 72076 2017-06-02
1881140648 Jacksonville North Pulaski School District Local Education Agency (LEA) 1414 West Main, Jacksonville, AR 72076 2016-08-31
1134599772 Jeremiah Melson Fleeman Occupational Therapist 2701 Tpwhite Drive, Jacksonville, AR 72076 2015-09-25
1821424565 Kasey Michele Leeson Social Worker 2520 W. Main St., Jacksonville, AR 72076 2013-09-25
1407104052 Cesalie Deonne Wallace Nurse Practitioner 3000 North First Street, Jacksonville, AR 72076 2012-08-29
1952660995 Joshua Aaron Hill Case Manager/Care Coordinator 2126 N. 1st St Suite F, Jacksonville, AR 72076 2012-05-11
1396023156 Syreeta Tucker Case Manager/Care Coordinator 1109 Burman, Jacksonville, AR 72076 2011-07-28
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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

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1467060434 Rebecca Bertone Nurse Practitioner 8540 Turkey Oaks Dr S, Jacksonville, FL 32277-2920 2020-07-16
1861018616 Octavia J Robertson Nurse Practitioner 3562 Boone Park Ave, Jacksonville, FL 32205-8433 2020-06-17
1902428568 Kimberly J Grant Nurse Practitioner 8680 Baymeadows Rd E Apt 1413, Jacksonville, FL 32256-4002 2020-05-17
1447710900 Shannska Atis Nurse Practitioner 580 W 8th St Fl II5, Jacksonville, FL 32209-6533 2019-03-21
1811462237 Dzenefa Ramic Nurse Practitioner 10175 Fortune Pkwy Unit 206, Jacksonville, FL 32256-6748 2018-10-11
1851871024 Shakhia Grant Nurse Practitioner 3636 University Blvd S Ste B, Jacksonville, FL 32216-4223 2018-08-17
1295230845 Lacey Cawthron Nurse Practitioner 8130 Baymeadows Cir W Ste 109, Jacksonville, FL 32256-1837 2018-03-27
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Competitor

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City JACKSONVILLE
Zip Code 72076

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Dataset Information

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.

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