Active NPI
Mallory R Mumma, ARNP
- Gerontology Nurse Practitioner
- Olympia, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- AP70030539
- Practice address
- 209 Lilly Rd NE Ste B
Olympia, WA 98506-5030 - Phone
- (360) 413-8250
- NPI assigned
- Jun 18, 2025
- Last updated
- Aug 11, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | AP70030539 | WA | Primary |
| Gastroenterology Registered Nurse | 163WG0100X | 60412207 | WA |
Addresses
Primary practice location
209 Lilly Rd NE Ste B
Olympia, WA 98506-5030
Mailing address
1203 Ebbets Dr SW
Tumwater, WA 98512-4606
Phone (503) 805-0845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
209 Lilly Rd NE
Suite B
Olympia, WA 98506-5030
Phone (360) 413-8250
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60412207 | WA | MD | Gastroenterology Registered Nurse |
| AP70030539 | WA | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Puget Sound Gastroenterology, PLLC | Current | Accepting new patients | |
| Puget Sound Gastroenterology, PLLC | Current | Accepting new patients | |
| Puget Sound Gastroenterology, PLLC | Past | Accepting new patients |
Locations
13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700
209 Lilly Rd NE
Ste B
Olympia, WA 98506
Phone (360) 413-8250
Interoperability endpoints
- mallory.mumma@gastrohealth.eclinicaldirectplus.com
Organizations & group practices 3
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.
-
dba PSG Division of Pathology
- Clinical Medical Laboratory
- Lynnwood, WA
- NPI 1689646838
-
- Gastroenterology Physician
- Olympia, WA
- NPI 1386340164
-
dba Fremont Endoscopy Center
- Ambulatory Surgical Clinic/Center
- Seattle, WA
- NPI 1386615912
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Tacoma General Allenmore
- General Acute Care Hospital
- Tacoma, WA
- NPI 1366556227
-
dba Mason General Hospital Family Health
- Clinic/Center
- Shelton, WA
- NPI 1700111986
Hospital
-
dba Mason Health-Mason General Hospital
- Critical Access Hospital
- Shelton, WA
- NPI 1760568752
-
dba Mason General Hospital Ankle Foot
- Foot & Ankle Surgery Podiatrist
- Shelton, WA
- NPI 1437486248
Hospital
-
dba Mason General Hospital Surgery Clinic
- Surgery Physician
- Shelton, WA
- NPI 1639339666
Hospital
-
dba Mason County Eye Clinic
- Ophthalmologic Surgery Clinic/Center
- Shelton, WA
- NPI 1922196609
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754870400000",
"number": "1801783402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 EBBETS DR SW",
"city": "TUMWATER",
"state": "WA",
"postal_code": "985124606",
"telephone_number": "503-805-0845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 LILLY RD NE STE B",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985065030",
"telephone_number": "360-413-8250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUMMA",
"first_name": "MALLORY",
"middle_name": "R",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-18",
"last_updated": "2025-08-11",
"certification_date": "2025-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "WA",
"license": "AP70030539",
"primary": true
},
{
"code": "163WG0100X",
"taxonomy_group": "",
"desc": "Registered Nurse, Gastroenterology",
"state": "WA",
"license": "60412207",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
- Joseph C Mulrean, DMD
- Multicare Health System (Olympic Sports & Spine)
- Multicare Health System (Olympic Sports & Spine)
- Multicare Health System (ABC Pediatrics by Mary Bridge Children's)
- Multicare Health System (MultiCare Capital Medical Center)
- Clarissa Munoz, PHARMD
- David K. Munson, MD
- Sally E. Munson, MD
- Shivani Mohan Murarka, M.D.
- Miri Murayama, MSW,MHP, CMHS, LICSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.