Mallory Boyette
Individual provider Active NPI Family Nurse Practitioner · Savannah, GA
NPI 1013578640 · NPPES record last updated Apr 22, 2024
Key facts
- NPI
- 1013578640
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN234868 (GA)
- Practice address
- 5354 Reynolds Street
Professional Building Suite 318
Savannah, GA 31405 - Phone
- (912) 819-4870
- NPI assigned
- Jun 25, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Theoria Medical
Complexcare Medical Group Southeast H PLLC
Practice addresses (Care Compare)
6711 La Roche Ave
Savannah, GA 31406-3101
Phone (248) 660-1220
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240604003066 | GA | Practitioner - Nurse Practitioner | 7911449004 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN234868 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Theoria Medical | Current |
Accepting new patients | |
| Complexcare Medical Group Southeast H PLLC | Current |
Accepting new patients | |
| Complexcare Medical Group Midwest M PLLC | Past | Accepting new patients |
Locations
604 N Camellia Blvd
Fort Valley, GA 31030
Phone (478) 355-3000
4000 Village View Dr
Gainesville, GA 30506
Phone (678) 450-3000
6711 La Roche Ave
Savannah, GA 31406
Phone (912) 354-8225
7300 Lester Rd
Union City, GA 30291
Phone (770) 703-2604
41800 W 11 Mile Rd
Novi, MI 48375
Phone (248) 282-5044
41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN234868 | GA | Yes |
Addresses
Primary practice location
5354 Reynolds Street
Professional Building Suite 318
Savannah, GA 31405
Mailing address
5354 Reynolds Street
Professional Building Suite 318
Savannah, GA 31405
Phone (912) 819-4870
Other providers in Savannah, GA
- Bethany Rozeboom Bowling
- Buffi G Boyd
- Carl Richard Boyd
- Jennifer Boyd
- Megan Boyd
- Maryjo Boyles
- Lisa A Bozik
- Mikayla C Brabham
- Brittaney Brackett
- Cheryl Ann Brackin
All providers in Savannah, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.