Miranda Mallicoat

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

TSA026 Issued in KY

Practice address

3900 Kresge Way Ste 51
Louisville, KY 40207-4683

Phone

(502) 259-5955

NPI assigned

Feb 21, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646784000000",
    "number": "1487309290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 COMMERCE CROSSINGS DR FL 3",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402292182",
            "telephone_number": "502-253-4924",
            "fax_number": "502-489-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 KRESGE WAY STE 51",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074683",
            "telephone_number": "502-259-5955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 State St Ste 250",
            "address_purpose": "LOCATION",
            "city": "New Albany",
            "state": "IN",
            "postal_code": "471506805",
            "country_code": "US",
            "telephone_number": "812-949-5933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLICOAT",
        "first_name": "MIRANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "KY",
            "license": "TSA026",
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "KY",
            "license": "TSA026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kira Lynn Malizia, LMT
• Mauri G Malka, LCSW
• Arthur Lalit/Laxman Malkani, M.D.
• Azzam Malkawi
• Dhiraj Mallela, BDS
• Carolyn T Mallillin, MD
• Mary Nan Mallory, M.D.
• Sharry D Mallory
• Madison Jean Malloy, LPCA
• Meghan Ann Malloy, MD

• Surgical Assistant in Louisville, KY
• Providers in Louisville, KY by specialty
• Surgical Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; 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.