Active NPI
Mallory McMahan
- Registered Dietitian
- Mount Vernon, IL
National Provider Identifier
1538032719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164022538
- Practice address
- 14521 N McCauley LN
Mount Vernon, IL 62864-7969 - Phone
- (618) 335-2092
- NPI assigned
- Sep 24, 2025
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164022538 | IL | Primary |
Addresses
Primary practice location
14521 N McCauley LN
Mount Vernon, IL 62864-7969
Mailing address
PO Box 18
Dix, IL 62830-0018
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164022538 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761264000000",
"number": "1538032719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 18",
"city": "DIX",
"state": "IL",
"postal_code": "628300018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14521 N MCCAULEY LN",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628647969",
"telephone_number": "618-335-2092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCMAHAN",
"first_name": "MALLORY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-24",
"last_updated": "2025-10-24",
"certification_date": "2025-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164022538",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.