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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
AR | 201676758 | 05 | |
AR | BCBS | 5PA17 | 01 |
Street Address |
1200 JAMES STREET |
City | JACKSONVILLE |
State | AR |
Zip Code | 72076-3143 |
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 |
Find all providers in the same location |
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 |
Find all providers in zip 72076 |
Taxonomy Code | 363LP0808X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Psych/Mental Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720691843 | Eralene Manangan | Nurse Practitioner | 4205 Belfort Rd Ste 4030, Jacksonville, FL 32216-1475 | 2020-08-28 |
1306456025 | Richard Mercer | Nurse Practitioner | 3545 Saint Johns Bluff Rd S Ste 137, Jacksonville, FL 32224-2682 | 2020-08-06 |
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 |
1083116107 | Kbn Healthcare, Pllc | Nurse Practitioner | 9471 Baymeadows Rd Ste 3, Jacksonville, FL 32256-7932 | 2018-03-05 |
Find all providers in JACKSONVILLE |
City | JACKSONVILLE |
Zip Code | 72076 |
Please comment or provide details below to improve the information on MALLORY LEEANN BROADAWAY.
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.