Individual ProviderMallory Louise DehaesNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address123 Baptist Way, Pensacola, FL 32503-2254(850) 434-4011(850) 361-7637PECOS EnrollmentBased on the most recent information from CMS, provider Mallory Louise Dehaes does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1992569909Provider TypeIndividualFull NameDehaes, Mallory LouiseGenderFemaleSole ProprietorNoEnumeration Date2/9/2024Last Updated2/9/2024Contact InformationPractice LocationPractice Address123 Baptist Way, Pensacola, FL 32503-2254Phone(850) 434-4011FaxUnlisted FaxMailing LocationMailing Address8316 Mobile Hwy, Pensacola, FL 32526-5217Phone(850) 361-7637FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAPRN11028583FloridaCode363LA2100XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAPRN11028583Florida