Active NPI
Tyler Mallory, CPS,CHW-C
- Peer Specialist
- Salisbury, MO
National Provider Identifier
1831998764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 17723
- Practice address
- 105 S Weber Ave
Salisbury, MO 65281-1071 - Phone
- (660) 338-5001
- NPI assigned
- Mar 12, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 17723 | MO | Primary |
Addresses
Primary practice location
105 S Weber Ave
Salisbury, MO 65281-1071
Mailing address
102 W Hill St
Huntsville, MO 65259-1197
Phone (660) 651-9102
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17723 | MO | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1741737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741737600000",
"number": "1831998764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 W HILL ST",
"city": "HUNTSVILLE",
"state": "MO",
"postal_code": "652591197",
"telephone_number": "660-651-9102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 S WEBER AVE",
"city": "SALISBURY",
"state": "MO",
"postal_code": "652811071",
"telephone_number": "660-338-5001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLORY",
"first_name": "TYLER",
"credential": "CPS,CHW-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-03-12",
"last_updated": "2025-03-12",
"certification_date": "2025-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Peer Specialist",
"state": "MO",
"license": "17723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salisbury, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.