Provider Demographics
NPI:1497630453
Name:MALLARD, TRISHA HAELYN (DNP)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:HAELYN
Last Name:MALLARD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16905 CASANOVA AVE
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4875
Mailing Address - Country:US
Mailing Address - Phone:435-328-9875
Mailing Address - Fax:
Practice Address - Street 1:16905 CASANOVA AVE
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4875
Practice Address - Country:US
Practice Address - Phone:435-328-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208470363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health