Lisa R Mallory, AGNP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

APRN74140-AGPCNP-BC Issued in WV

Practice address

506 Chestnut St
South Charleston, WV 25309-1204

Phone

(304) 766-8558

Fax

(304) 766-8561

NPI assigned

Mar 12, 2019

Last updated

Jan 7, 2021By 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 2

Addresses

Other names 1

• Lisa Adkins Former name

Medicare fee-for-service enrollment

Enrolled in WV

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

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

• THS Physician Partners Inc

  • Internal Medicine Physician
  • South Charleston, WV
  • NPI 1871866806
  Medicare reassignment NPD

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1598223216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091311",
            "telephone_number": "304-414-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 CHESTNUT ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091204",
            "telephone_number": "304-766-8558",
            "fax_number": "304-766-8561"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6A Bank St",
            "address_purpose": "LOCATION",
            "city": "Nitro",
            "state": "WV",
            "postal_code": "251431708",
            "country_code": "US",
            "telephone_number": "304-766-8558",
            "fax_number": "304-766-8561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "333 Laidley St",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253011614",
            "country_code": "US",
            "telephone_number": "304-347-6773",
            "fax_number": "304-347-6848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "LISA",
        "middle_name": "R",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-12",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WV",
            "license": "APRN74140-AGPCNP-BC",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WV",
            "license": "APRN741400AGPCNP-BC",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "ADKINS",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Main Street Pharmacy Inc (Clark's Family Pharmacy Inc.)
• Melissa Maker
• Amy Malcomb
• Barbara Jo Mallory
• Brooke Naomi Mallory
• Jauquita Brufaye Malone
• Alberta Jane Maloof, M.D.
• Tara Manchin
• Payton Grace Mangus
• John Henry Mani, MD

• Adult Health Nurse Practitioner in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Adult Health Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; 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.