Mallory Fawns

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

844690 Issued in CA

Practice address

6501 Coyle Ave
Carmichael, CA 95608-0306

Phone

(916) 537-5550

NPI assigned

Nov 4, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mallory Stafford Former name

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": "1415059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559260800000",
    "number": "1821493859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 COYLE AVE",
            "city": "CARMICHAEL",
            "state": "CA",
            "postal_code": "956080306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 COYLE AVE",
            "city": "CARMICHAEL",
            "state": "CA",
            "postal_code": "956080306",
            "telephone_number": "916-537-5550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Cirby Hills Dr",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956784360",
            "country_code": "US",
            "telephone_number": "916-787-8848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAWNS",
        "first_name": "MALLORY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-04",
        "last_updated": "2019-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "844690",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "844690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "STAFFORD",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Howard J Fan, M.D.
• Christina Lynn Fantozzi, PA-C
• Jamshid Faraji, M.D.
• Mehrnoush Fathi, MD
• Alina Fatima, MD
• Abdul Qasem Fazely
• Olha Fedorenko
• Erin Christine Feig, NP-C
• Kristin Ferguson, PT
• Erik Ferland

• Psychiatric/Mental Health Registered Nurse in Carmichael, CA
• Providers in Carmichael, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; 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.