Mallory Lake McCoy, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-06072 Issued in NC

Practice address

4601 Lake Boone TRL Ste 1B
Raleigh, NC 27607-7503

Phone

(919) 781-1800

Fax

(919) 781-1899

NPI assigned

Nov 24, 2015

Last updated

May 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Credentials

Physician Assistant

Practice roles

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.

• North Raleigh Ophthalmology, P.a.

  • Ophthalmology Physician
  • Raleigh, NC
  • NPI 1225195142
  NPD (past)

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

{
    "created_epoch": "1448323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1699149906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 LAKE BOONE TRL STE 1B",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077503",
            "telephone_number": "919-781-1800",
            "fax_number": "919-781-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 LAKE BOONE TRL STE 1B",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077503",
            "telephone_number": "919-781-1800",
            "fax_number": "919-781-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "MALLORY",
        "middle_name": "LAKE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-24",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis J McCoy-Cooper, LCSW
• Deandre Jermaine McCoy
• Destiny Monique Akua McCoy, LMT LE CCA
• Doreatha McCoy
• Keith McCoy, M.D.
• Megan Christina McCoy, PA-C
• Michael McCoy
• Sarah Ashley McCoy
• Shaderika Willis McCoy, NP
• Taryn Melissa McCoy

• Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.