Provider Demographics
NPI:1427432749
Name:CRANOR, MALLORY (APRN)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:CRANOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N SIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4389
Mailing Address - Country:US
Mailing Address - Phone:479-498-0858
Mailing Address - Fax:479-498-0809
Practice Address - Street 1:220 N SIDNEY AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4389
Practice Address - Country:US
Practice Address - Phone:479-498-0858
Practice Address - Fax:479-498-0809
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily