Mallory Shae Fochtman, CNP
Individual provider Active NPI Women's Health Nurse Practitioner · Bellbrook, OH
NPI 1104355510 · NPPES record last updated Oct 1, 2023
Key facts
- NPI
- 1104355510
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Women's Health Nurse Practitioner 363LW0102X
- License
- APRN.CNP.0035041 (OH)
- Practice address
- 2006 Cabernet Way
Bellbrook, OH 45305-7502 - Phone
- (719) 258-0848
- NPI assigned
- Jun 8, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN.CNP.0035041 | OH | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Planned Parenthood Southwest Ohio Region | Women'S Health | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | APRN.CNP.0035041 | OH | Yes |
Addresses
Primary practice location
2006 Cabernet Way
Bellbrook, OH 45305-7502
Mailing address
2006 Cabernet Way
Bellbrook, OH 45305-7502
Phone (719) 258-0848
Other names
- Mallory Stone
Other providers in Bellbrook, OH
- Joey Dulaney
- Earpro Audiology
- Express Care Medical Group
- Jason John Fisher
- Five Stones Therapy, LLC
- Margaret Clare Foley
- Charles Fubler
- Nicholas J Gambino
- Cynthia Gebhart
- Evan Geist
All providers in Bellbrook, OH · Women's Health Nurse Practitioner in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.