Provider Demographics
NPI:1891231007
Name:YOUNG, MALLORY NICOLE (PA)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:603 S CONROE MEDICAL DR STE 140
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5395
Mailing Address - Country:US
Mailing Address - Phone:936-978-0466
Mailing Address - Fax:936-978-0469
Practice Address - Street 1:603 S CONROE MEDICAL DR STE 140
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5395
Practice Address - Country:US
Practice Address - Phone:936-978-0466
Practice Address - Fax:936-978-0469
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2025-08-06
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Provider Licenses
StateLicense IDTaxonomies
TXPA11123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant