Claudette M Mallory, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN3174462 Issued in FL

Practice address

92 W Lowder St
Macclenny, FL 32063-2676

Phone

(904) 259-0092

Fax

(904) 259-0094

NPI assigned

Feb 16, 2006

Last updated

Aug 1, 2023By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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.

• Vitalmd Group Holding LLC

  • Obstetrics & Gynecology Physician
  • Miami, FL
  • NPI 1871572032
  Medicare reassignment NPD
• Heritage Wellness Center, LLC

  • Family Nurse Practitioner
  • Macclenny, FL
  • NPI 1952083495
  Authorized official Same address or phone

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1679547442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 W LOWDER ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632676",
            "telephone_number": "904-259-0092",
            "fax_number": "904-259-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 W LOWDER ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632676",
            "telephone_number": "904-259-0092",
            "fax_number": "904-259-0094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "836 Prudential Dr Ste 1103",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322078338",
            "country_code": "US",
            "telephone_number": "904-398-7654",
            "fax_number": "904-398-0118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "CLAUDETTE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-16",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN3174462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "770015600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Julian Lopez, MD
• Brandon T Loray
• Melissa Ludington, PHARM D.
• Taylor Lyles
• Macclenny Pharmacy Company
• Margaret L. Romeo, D.M.D.,P.a.
• Mary M Futch OD PA (Baker Vision Care)
• Shakeira S Maxwell
• Brookes McClellan, ARNP
• Steven Douglas McClintock, DDS

• Family Nurse Practitioner in Macclenny, FL
• Providers in Macclenny, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.