Active NPI
Mallory McCallister, BSN, RN
- Registered Nurse
- Newburgh, IN
National Provider Identifier
1174328918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 28275258A
- Practice address
- 4199 Gateway Blvd
Newburgh, IN 47630-8940 - Phone
- (812) 842-4309
- NPI assigned
- Feb 17, 2025
- Last updated
- Feb 17, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28275258A | IN | Primary |
Addresses
Primary practice location
4199 Gateway Blvd
Newburgh, IN 47630-8940
Mailing address
405 Old Cannon Way
Evansville, IN 47711-1577
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
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28275258A | IN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739750400000",
"number": "1174328918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 OLD CANNON WAY",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477111577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4199 GATEWAY BLVD",
"city": "NEWBURGH",
"state": "IN",
"postal_code": "476308940",
"telephone_number": "812-842-4309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCALLISTER",
"first_name": "MALLORY",
"credential": "BSN, RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-17",
"last_updated": "2025-02-17",
"certification_date": "2025-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IN",
"license": "28275258A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newburgh, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.