Mallory Elyse Maisel, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1126359 Issued in TX

Practice address

4710 NE Stallings Dr
Nacogdoches, TX 75965-1615

Phone

(936) 560-2666

Fax

(936) 568-2681

NPI assigned

Jun 19, 2023

Last updated

Jun 19, 2023By 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

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nacogdoches Womens Center, PLLC

  • Obstetrics & Gynecology Physician
  • Nacogdoches, TX
  • NPI 1669988465
  Medicare reassignment NPD
• Rose Imaging Specialists PA

  dba Solis Mammography

  • Diagnostic Ultrasound Physician
  • Houston, TX
  • NPI 1164478186
  NPD (past)

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1477238368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4710 NE STALLINGS DR",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651615",
            "telephone_number": "936-560-2666",
            "fax_number": "936-568-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4710 NE STALLINGS DR",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651615",
            "telephone_number": "936-560-2666",
            "fax_number": "936-568-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAISEL",
        "first_name": "MALLORY",
        "middle_name": "ELYSE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1126359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• M & S Pharmacy, Inc.
• Veronica Macias
• Patricia Sue Madison
• Kelly Tricia Madkins, LMSW
• Main Street Anesthesia of Texas, PA
• Stephanie S Malleo
• Larry D Malone, FNP
• Malonegrove Family Care & Rehabilitation LLC
• H. Lance Mandell, M.D.
• Marian Kathleen Querry DO PC

• Family Nurse Practitioner in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.