Mallory Jacob Walsh

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1466 Issued in NH

Practice address

100 Main St Apt 205
Pembroke, NH 03275-1241

Phone

(802) 274-8902

NPI assigned

Oct 24, 2018

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Littleton Hospital Association

  • Critical Access Hospital
  • Littleton, NH
  • NPI 1144223702

  NH

  Medicare reassignment NPD
• Littleton Hospital Association

  • Durable Medical Equipment & Medical Supplies
  • Littleton, NH
  • NPI 1174398846
  NPD

Medicare fee-for-service enrollment

Enrolled in NH

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

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 18, 2019.

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555545600000",
    "number": "1780151001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NEW HAMPSHIRE AVE STE 2",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038012864",
            "telephone_number": "603-319-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAIN ST APT 205",
            "city": "PEMBROKE",
            "state": "NH",
            "postal_code": "032751241",
            "telephone_number": "802-274-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "MALLORY",
        "middle_name": "JACOB",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-24",
        "last_updated": "2019-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Town of Pembroke
• Tradewinds Counseling and Consulting, LLC
• Cynthia Anne Tranchemontagne, PA-C
• Tri Town Volunteer Emergency Ambulance Service Inc
• Valerie Jones, PLLC
• Brittany Wells, RDN, LD
• Marissa Wonson
• Marcia Jean Wurster
• Kelly Renee Zum Wald

• All providers in Pembroke, NH
• Physician Assistant in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; 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.