Physician Assistant
MALLORY BOURG
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1164816831 · enumerated 2015-03-20 · record updated 2023-09-29. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Addresses and phones
- Practice location 7777 HENNESSY BLVD, SUITE 701, BATON ROUGE, LA, 70808-4300 (225) 765-5864 Fax (225) 765-2013 Google Maps Apple Maps OpenStreetMap
- Mailing address 5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA, 70816-6038 (225) 526-0006 Fax (225) 765-9291 Google Maps Apple Maps OpenStreetMap
Specialties
- Physician Assistant 363A00000X · Primary · License 200789 LA
In this directory
Locations and evidence
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Practice location
BATON ROUGE, LA, 708084300
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.