Active NPI
Hileen E Mallory, PA
- Medical Physician Assistant
- Kermit, TX
National Provider Identifier
1831172873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA09912
- Practice address
- 828 Myer LN
Kermit, TX 79745-4634 - Phone
- (432) 586-2040
- NPI assigned
- Nov 23, 2005
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA003289L | PA | |
| Medical Physician Assistant | 363AM0700X | PA09912 | TX | Primary |
Addresses
Primary practice location
828 Myer LN
Kermit, TX 79745-4634
Mailing address
828 Myer LN
Kermit, TX 79745-4634
Phone (432) 586-2040
Other names 1
- Hileen E Doherty
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA003289L | PA | MD | Medical Physician Assistant |
| PA09912 | TX | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441670400000",
"number": "1831172873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "828 MYER LN",
"city": "KERMIT",
"state": "TX",
"postal_code": "797454634",
"telephone_number": "432-586-2040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "828 MYER LN",
"city": "KERMIT",
"state": "TX",
"postal_code": "797454634",
"telephone_number": "432-586-2040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLORY",
"first_name": "HILEEN",
"middle_name": "E",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-23",
"last_updated": "2015-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA003289L",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA09912",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "HILEEN",
"last_name": "DOHERTY",
"middle_name": "E",
"credential": "PA",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Kermit, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.