Mallory Mozley Nottenkamper, PA-C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

PA-1386 Issued in AL

Practice address

188 Hospital Dr Ste 202
Fairhope, AL 36532-2038

Phone

(251) 990-1922

NPI assigned

Oct 5, 2018

Last updated

Oct 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1538697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538697600000",
    "number": "1356816359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12626 DOMINION DR",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365327704",
            "telephone_number": "251-228-2389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 HOSPITAL DR STE 202",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365322038",
            "telephone_number": "251-990-1922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOTTENKAMPER",
        "first_name": "MALLORY",
        "middle_name": "MOZLEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-05",
        "last_updated": "2018-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "PA-1386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Fairhope, AL
• Providers in Fairhope, AL by specialty
• Internal Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.