Mallory Anne Logsdon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9106949 Issued in FL

Practice address

5507 S Congress Ave
Suite 140
Lake Worth, FL 33462-1139

Phone

(561) 965-6685

NPI assigned

Jan 15, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1358208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390780800000",
    "number": "1306183090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5507 S CONGRESS AVE",
            "address_2": "SUITE 140",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334621139",
            "telephone_number": "561-965-6685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5507 S CONGRESS AVE",
            "address_2": "SUITE 140",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334621139",
            "telephone_number": "561-965-6685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGSDON",
        "first_name": "MALLORY",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-15",
        "last_updated": "2014-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hyo Young Joshua Llopiz, DPT
• Yorbania Ofelia Lluch Escobar
• Daniela Loebl
• Michael Jerome Loftus, D.C.
• Scott Andrew Logan, PTA
• Alanna Loli, PCD (DONA)
• Steven Lewis Lomax, P.T.
• Lonnie Tuman P a
• Lidiana Lopez Batista
• Livan Leonel Lopez Lima

• Physician Assistant in Lake Worth, FL
• Providers in Lake Worth, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.