Mallory Dawn Mudd Pomerville, IBCLC, LPN

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

L-41930 Issued in FL

Practice address

1538 Bowfin CT
Unit D
Key West, FL 33040-6725

Phone

(660) 909-2350

NPI assigned

Mar 31, 2014

Last updated

Mar 31, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396224000000",
    "number": "1174941892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1538 BOWFIN CT",
            "address_2": "UNIT D",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330406725",
            "telephone_number": "660-909-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1538 BOWFIN CT",
            "address_2": "UNIT D",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330406725",
            "telephone_number": "660-909-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDD POMERVILLE",
        "first_name": "MALLORY",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "IBCLC, LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-31",
        "last_updated": "2014-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "FL",
            "license": "L-41930",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN 5214349",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lactation Consultant (Registered Nurse) in Key West, FL
• Providers in Key West, FL by specialty
• Lactation Consultant (Registered Nurse) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.