Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lisa R Mallory, AGNP-C

Individual provider Gerontology Nurse Practitioner · NPI 1598223216

Lisa R Mallory, AGNP-C is a Gerontology Nurse Practitioner in South Charleston, West Virginia. Works from 3 locations. Licensed in West Virginia.

Licensed in
WV
In the registry since
2019
Specialties on file
2

Practice location Address checks out

506 Chestnut St
South Charleston, WV 25309-1204
Phone: (304) 766-8558
Fax: (304) 766-8561
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 333 Laidley St, Charleston, WV 25301-1614 — (304) 347-6773
  • 6a Bank St, Nitro, WV 25143-1708 — (304) 766-8558

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence APRN74140-AGPCNP-BC (WV)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence APRN741400AGPCNP-BC (WV)

Record details

NPI number1598223216
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGNP-C
Sole proprietorNo
NPI enumeratedMarch 12, 2019
Last updated in NPPESJanuary 7, 2021
Certification dateJanuary 7, 2021

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