Individual provider Active NPI

Mary Mallory, NP

  • Adult Health Nurse Practitioner
  • Norfolk, VA
National Provider Identifier
1629587530
Registry record updated May 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
0024174999 Issued in VA
Practice address
6160 Kempsville Cir Ste 325a
Norfolk, VA 23502-3933
Phone
(757) 354-2885
NPI assigned
Sep 22, 2017
Last updated
May 15, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 0024174999 VA Primary
Gerontology Nurse Practitioner 363LG0600X 0024174999 VA

Addresses

Primary practice location

6160 Kempsville Cir Ste 325a
Norfolk, VA 23502-3933

Mailing address

900 Mountain Laurel TRL
Virginia Beach, VA 23454-3552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20171116002120 DC Practitioner - Nurse Practitioner 1951667450 Reassigns benefits to 1 organization
I20171201000098 VA Practitioner - Nurse Practitioner 1951667450 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SE Virginia Value Based Care LLCGroup PAC ID 6103288170, 160 clinicians
Mid-Atlantic Post Acute and Long Term Care PLLCGroup PAC ID 0648530782, 142 clinicians

Practice addresses (Care Compare)

Norfolk, VA 23502
Phone (757) 354-2885

6160 Kempsville Cir
Suite 325a
Norfolk, VA 23502-3933
Phone (757) 354-2885

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024174999VAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Oct 24, 2017 Accepting new patients
Mid-Atlantic Post Acute & Long Term Care PLLC Adult Health CurrentSince Oct 1, 2019 Accepting new patients
SE Virginia Value Based Care, LLC CurrentSince Aug 1, 2023 Accepting new patients
Privia Medical Group, LLC CurrentSince Oct 24, 2017 Accepting new patients

Locations

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

7202 Poplar St
Ste E
Annandale, VA 22003
Phone (571) 830-6195

8644 Sudley Rd
#220
Manassas, VA 20110

6160 Kempsville Cir
Ste 325A
Norfolk, VA 23502
Phone (757) 354-2885

6171 Kempsville Cir
Norfolk, VA 23502
Phone (757) 622-2208

1148 First Colonial Rd
Virginia Beach, VA 23454
Phone (757) 481-3321

4560 Princess Anne Rd
Virginia Beach, VA 23462
Phone (757) 474-1249

5580 Daniel Smith Rd
Virginia Beach, VA 23462
Phone (757) 449-7029

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778803200000",
    "number": "1629587530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MOUNTAIN LAUREL TRL",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 KEMPSVILLE CIR STE 325A",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235023933",
            "telephone_number": "757-354-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "MARY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-22",
        "last_updated": "2026-05-15",
        "certification_date": "2026-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024174999",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "VA",
            "license": "0024174999",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.