Individual provider Active NPI

Mallory Ann Shepkosky, APRN, FNP-C

  • Nurse Practitioner
  • Fort Pierce, FL
National Provider Identifier
1235806019
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11013690 Issued in FL
Practice address
2100 Nebraska Ave Ste 201
Fort Pierce, FL 34950-4832
Phone
(772) 465-8100
NPI assigned
Aug 27, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11013690 FL
Nurse Practitioner 363L00000X 11013690 FL Primary

Addresses

Primary practice location

2100 Nebraska Ave Ste 201
Fort Pierce, FL 34950-4832

Mailing address

5510 Myrtle Dr
Fort Pierce, FL 34982-3885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220114000220 FL Practitioner - Nurse Practitioner 8729470190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lawnwood Cardiovascular Surgery LLCGroup PAC ID 7214937598, 53 clinicians

Practice addresses (Care Compare)

2100 Nebraska Ave
Suite 201
Fort Pierce, FL 34950-4832
Phone (772) 465-8100

Hospital & facility affiliations

  • HCA Florida Lawnwood Hospital Hospital, Fort Pierce, FL, CCN 100246

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11013690FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lawnwood Cardiovascular Surgery LLC CurrentSince Dec 5, 2022 Accepting new patients
Thoracic & Cardiovascular Surgeons LLC Past Accepting new patients

Locations

5301 S Congress Ave
Bldg 300
Atlantis, FL 33462
Phone (561) 548-4900

2100 Nebraska Ave
Ste 201
Fort Pierce, FL 34950
Phone (772) 461-1191

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: mallory.shepkosky@hca4.eclinicaldirectplus.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1235806019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5510 MYRTLE DR",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349823885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 NEBRASKA AVE STE 201",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504832",
            "telephone_number": "772-465-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPKOSKY",
        "first_name": "MALLORY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-27",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11013690",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11013690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

Verify at the official NPI Registry.