Michelle Mallory, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86028933 Issued in NV

Practice address

3802 Meadows LN
Las Vegas, NV 89107-3112

Phone

(702) 313-8446

Fax

(702) 221-8446

NPI assigned

Apr 28, 2014

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

Other identifiers 1

Other names 1

• Michelle Northup Former name

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

University of Nevada School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Desert Springs Medical Group-Atkinson PCGroup PAC ID 5193988863, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Uhs of Desert Springs, Inc.

  • Surgery Physician
  • Henderson, NV
  • NPI 1801152855

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD
• Centennial Hills Hospital Medical Center

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1487771812
  NPD (past)
• Desert Springs Hospital

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1154317964
  NPD (past)
• Dignity Health

  • General Acute Care Hospital
  • Henderson, NV
  • NPI 1447393152
  NPD (past)
• Sunrise Mountainview Hospital, Inc.

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1831143817
  NPD (past)

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

{
    "created_epoch": "1398643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506556800000",
    "number": "1477963650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 E. PRATER WAY, SUITE 207",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "89434",
            "telephone_number": "775-356-9393",
            "fax_number": "775-356-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 MEADOWS LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891073112",
            "telephone_number": "702-313-8446",
            "fax_number": "702-221-8446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "MICHELLE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-28",
        "last_updated": "2017-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NV",
            "license": "86028933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477963650",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "NORTHUP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer C. Mallinger, O.D. CHARTERED
• Lisa Annette Mallinger, LICENSED MFT
• Ann Marie Mallory, APRN, FNP, PMHNP
• Gwendolyn Mallory, QMHA
• Louis Joseph Mallory IV
• Natalee Adell Mallory, LCSW
• Rasheena Mallory
• Kelley Malloy
• Magdalena Agnieszka Malloy, APRN
• Shaneka Javone Malloyd, BA

• Registered Dietitian in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Registered Dietitian in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.