Active NPI
Mallory Thurmond, CRNP
- Nurse Practitioner
- Philadelphia, PA
National Provider Identifier
1366391179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- SP034280
- Practice address
- 333 Cottman Ave
Philadelphia, PA 19111-2434 - Phone
- (215) 728-2570
- Fax
- (215) 728-3639
- NPI assigned
- Jan 26, 2026
- Last updated
- May 11, 2026
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | SP034280 | PA | Primary |
Addresses
Primary practice location
333 Cottman Ave
Philadelphia, PA 19111-2434
Mailing address
3509 N Broad St
Philadelphia, PA 19140-4105
Phone (215) 707-3911
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Baylor College of Medicine, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
333 Cottman Ave
Philadelphia, PA 19111-2434
Phone (215) 707-2111
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP034280 | PA | MD | Nurse Practitioner |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Temple Faculty Anesthesiology Associates
- Anesthesiology Physician
- Philadelphia, PA
- NPI 1881176949
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1769385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778457600000",
"number": "1366391179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3509 N BROAD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191404105",
"telephone_number": "215-707-3911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 COTTMAN AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191112434",
"telephone_number": "215-728-2570",
"fax_number": "215-728-3639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THURMOND",
"first_name": "MALLORY",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-01-26",
"last_updated": "2026-05-11",
"certification_date": "2026-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "PA",
"license": "SP034280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.