Ethan Davis Mallory, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2025036708 Issued in MO

Practice address

3201 McClelland Blvd
Suite B
Joplin, MO 64804

Phone

(417) 347-6625

NPI assigned

Oct 27, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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": "1761523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761523200000",
    "number": "1922976422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3708 CHELSEA",
            "city": "WEBB CITY",
            "state": "MO",
            "postal_code": "648709572",
            "telephone_number": "417-483-2014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 MCCLELLAND BLVD",
            "address_2": "SUITE B",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "telephone_number": "417-347-6625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "ETHAN",
        "middle_name": "DAVIS",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-10-27",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2025036708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ann Mais
• Marlon Makdisi
• Charbel I Maksoud, M.D.
• Ali Abdullah Malhi
• Maria Malhi
• Prashant Malviya, M.D.
• Talon Maningas, D.O.
• Brittan Kylee Manley
• Casey Creed Mann
• Robert Edward Mann, MD

• Family Nurse Practitioner in Joplin, MO
• Providers in Joplin, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2025; 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.