NPIMap

Individual provider Active NPI

Mallory Wathen Lynch, APRN

  • Family Nurse Practitioner
  • Brandenburg, KY
National Provider Identifier
1720508120
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3011343 Issued in KY
Practice address
815 Hillcrest Dr
Brandenburg, KY 40108-1415
Phone
(270) 422-4111
Fax
(270) 422-3629
NPI assigned
Jun 27, 2017
Last updated
Aug 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3011343 KY Primary

Addresses

Primary practice location

815 Hillcrest Dr
Brandenburg, KY 40108-1415

Mailing address

PO Box 909
Louisville, KY 40201-0909
Phone (502) 588-0330

Other names 1

  • Ms. Mallory Ann Wathen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170706001222 KY Practitioner - Nurse Practitioner 8224307269 Reassigns benefits to 1 organization

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

Practice addresses (Care Compare)

4402 Churchman Ave
Suite 400
Louisville, KY 40215-3102
Phone (502) 899-3623

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3011343KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. CurrentSince Sep 4, 2024 Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Sep 4, 2024 Accepting new patients
Meade Physicians, Inc. Family CurrentSince Jun 9, 2017 Accepting new patients
University of Louisville Physicians Inc. Past Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

815 Hillcrest Dr
Brandenburg, KY 40108
Phone (270) 422-3366

4402 Churchman Ave
#400
Louisville, KY 40215
Phone (502) 361-1042

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

Interoperability endpoints

  • Direct secure messaging: mlynch44741@uoflhealth-dm.org

Organizations & group practices 5

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 6

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": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1720508120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-588-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 HILLCREST DR",
            "city": "BRANDENBURG",
            "state": "KY",
            "postal_code": "401081415",
            "telephone_number": "270-422-4111",
            "fax_number": "270-422-3629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYNCH",
        "first_name": "MALLORY",
        "middle_name": "WATHEN",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3011343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "WATHEN",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brandenburg, KY

Sources for this page

Verify at the official NPI Registry.