Active NPI
Tisha Dawn Mallow
- Homemaker
- Buckhannon, WV
National Provider Identifier
1003410408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Homemaker
- Practice address
- 8 N Spring St
Buckhannon, WV 26201-2720 - Phone
- (304) 472-0395
- Fax
- (304) 471-2488
- NPI assigned
- Nov 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | |||
| Homemaker | 376J00000X | Primary |
Addresses
Primary practice location
8 N Spring St
Buckhannon, WV 26201-2720
Mailing address
101 Caboose Drive
Harman, WV 26270
Phone (304) 704-5479
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | caderiley@hotmail.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696204800000",
"number": "1003410408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 CABOOSE DRIVE",
"city": "HARMAN",
"state": "WV",
"postal_code": "26270",
"telephone_number": "304-704-5479",
"fax_number": "304-471-2488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 N SPRING ST",
"city": "BUCKHANNON",
"state": "WV",
"postal_code": "262012720",
"telephone_number": "304-472-0395",
"fax_number": "304-471-2488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLOW",
"first_name": "TISHA",
"middle_name": "DAWN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-25",
"last_updated": "2023-10-02",
"certification_date": "2023-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": null,
"license": null,
"primary": false
},
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "caderiley@hotmail.com",
"affiliation": "N",
"endpointDescription": "EMAIL",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "8 N Spring St",
"city": "Buckhannon",
"state": "WV",
"country_code": "US",
"postal_code": "262012720",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Buckhannon, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.