Mallory Ruth Wisdom, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

216033 Issued in AR

Practice address

1233 W Poplar St
Rogers, AR 72756-4245

Phone

(479) 636-9235

Fax

(479) 751-2878

NPI assigned

Dec 4, 2024

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

Enrolled in AR

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Roller Weight Loss Institute, Inc.Group PAC ID 0446398770, 24 clinicians

St. Francis House Nwa, Inc.Group PAC ID 0042262495, 67 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• St Francis House Nwa, Inc

  dba Community Clinic Central Junior High

  • Federally Qualified Health Center (FQHC)
  • Springdale, AR
  • NPI 1821838996
  Medicare reassignment Care Compare group NPD
• Roller Weight Loss Institute,Inc.

  • Specialist
  • Fayetteville, AR
  • NPI 1073743399
  Medicare reassignment Care Compare group
• St Francis House Nwa, Inc

  dba Community Clinic West Fork

  • Federally Qualified Health Center (FQHC)
  • West Fork, AR
  • NPI 1336986785
  NPD
• St. Francis House Nwa, Inc

  dba Community Clinic Siloam Springs Medical

  • Federally Qualified Health Center (FQHC)
  • Siloam Springs, AR
  • NPI 1417197245
  NPD
• St. Francis House Nwa, Inc.

  dba Community Clinic Rogers Medical

  • Federally Qualified Health Center (FQHC)
  • Rogers, AR
  • NPI 1710160098
  NPD (past)

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

• Mercy Hospital Rogers

  dba Mercy Hospital Northwest Arkansas

  • General Acute Care Hospital
  • Rogers, AR
  • NPI 1316902414
  Care Compare affiliation

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1396551412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 N 34TH ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727569151",
            "telephone_number": "870-362-0914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 W POPLAR ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727564245",
            "telephone_number": "479-636-9235",
            "fax_number": "479-751-2878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISDOM",
        "first_name": "MALLORY",
        "middle_name": "RUTH",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-04",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "216033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Jo Winsemius-Hackney, PTA
• Nolan Winslow, M.D.
• Molly Jean Winter, MS
• Lrae Urainuz Wintercorn, FNP-BC
• Shannon Wipf, MD
• Susan Heady Wiseman, CRNA
• Wisener & Cooper, D.D.S.
• Wisener, Cooper & Fergus DDS PLLC (Wisener, Cooper & Fergus DDS)
• James Wayne Wisener III, DDS
• Jeffery Scott Wisener, D.D.S.

• Family Nurse Practitioner in Rogers, AR
• Providers in Rogers, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; 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.

Verify at the official NPI Registry.