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

Mallory Bourg

Individual provider Physician Assistant · NPI 1164816831

Mallory Bourg is a Physician Assistant in Baton Rouge, Louisiana. Licensed in Louisiana. Registered with an NPI since 2015.

Licensed in
LA
In the registry since
2015

Practice location Address checks out

7777 Hennessy Blvd Ste 701
Baton Rouge, LA 70808-4300
Phone: (225) 765-5864
Fax: (225) 765-2013
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 200789 (LA)

Record details

NPI number1164816831
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 20, 2015
Last updated in NPPESSeptember 29, 2023
Certification dateSeptember 29, 2023

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