MALLORY KRISTEN MARTHA (NPI# 1255961959) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255961959 |
| Entity Type | Individual |
| Full Name | MALLORY KRISTEN MARTHA |
| Other Name | MALLORY KRISTEN HODGKINSON |
| Credential | NP |
| Practice Address |
4700 S Washington St Ste G Grand Forks ND 58201-8123 |
| Mailing Address |
Po Box 5210 Grand Forks ND 58206-5210 |
| Practice Telephone | 7012053000 |
| Practice Fax Number | 7017322501 |
| Mailing Telephone | 7012053000 |
| Mailing Fax Number | 7017322501 |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2020-07-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 9426584 | FL | Nursing Service Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
828441 | NV | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
161921 | AK | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
7531 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
R48854 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4700 S WASHINGTON ST STE G |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201-8123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306819941 | David B Eberly | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2006-02-13 |
| 1073137915 | Hannah Lee Abner | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8155 | 2020-06-06 |
| 1023663598 | Devon Nicole Anderson | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2019-08-01 |
| 1255983888 | Danielle Collins | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2019-07-13 |
| 1659889798 | Natasha Marie Krebs | Registered Nurse | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2018-01-10 |
| 1730695412 | Mio Watanabe | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2017-12-18 |
| 1972012482 | Mallory Driscoll | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2017-09-27 |
| 1699295774 | Peterson Medical Clinics, LLC | Clinic/Center | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2017-06-21 |
| 1073067823 | Riki Gifford-ferguson | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2016-08-10 |
| 1720435175 | Katie Marie Allen | Social Worker | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2016-05-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1225523004 | Alicia Mae Mack | Registered Nurse | 212 S. 4th St. Suite 301, Spectra Health, Grand Forks, ND 58201 | 2018-06-25 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| Find all providers in zip 58201 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447735030 | Lisa Marie Clinkscales | Nurse Practitioner | 521 S 6th St, Grand Forks, ND 58201-4617 | 2018-09-28 |
| 1104443449 | Maren Lynn Lysne | Nurse Practitioner | 860 S Columbia Rd, Grand Forks, ND 58201-4028 | 2020-07-02 |
| 1821620840 | Agnes Olaolu Olowolagba | Nurse Practitioner | 1451 44th Ave S Ste A, Grand Forks, ND 58201-3434 | 2020-02-07 |
| 1790347268 | Courtney Naastad | Nurse Practitioner | 1200 S Columbia Rd, Grand Forks, ND 58201 | 2019-07-03 |
| 1669756755 | Stacie Lynn Olson | Nurse Practitioner | 860 S Columbia Rd, Grand Forks, ND 58201-4028 | 2011-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346860541 | Inspired Healthcare, Pllc | Nurse Practitioner | 1301 6th Ave Sw, Jamestown, ND 58401-5220 | 2020-04-17 |
| 1881138238 | Ashley A Beeter, Pmh-dnp | Nurse Practitioner | 24 North Main Street, Suite K, Minot, ND 58703 | 2016-12-05 |
| 1346792561 | Heather Counts | Nurse Practitioner | 11 Main Street East, Dunseith, ND 58329 | 2016-11-04 |
| 1831431949 | Ashley Ann Thiel | Nurse Practitioner | 24 Main St N, Suite K, Minot, ND 58703-3104 | 2013-03-27 |
| 1336481803 | Jacqualine Kay Gervais | Nurse Practitioner | 510. 4th St S, Prairie St. John's, Fargo, ND 58103 | 2013-03-22 |
| 1366782609 | Wanda Ann Sprenger | Nurse Practitioner | 407 3rd St. S.e., Minot, ND 58701-4470 | 2013-02-24 |
| 1275845547 | Nicole Olivia Wilson | Nurse Practitioner | 914 1st Ave Se, Minot, ND 58701-4008 | 2010-07-02 |
| 1841443025 | Lisa Karen Watkins | Nurse Practitioner | 1850 Billings Dr, Bismarck, ND 58504-7251 | 2008-10-31 |
| 1275715682 | Jennifer L Keplin | Nurse Practitioner | 1015 Hospital Rd. Suite A, Belcourt, ND 58316 | 2007-11-28 |
| 1740887207 | Sheila Kinzler | Nurse Practitioner | 2430 20th St Sw, Jamestown, ND 58401-6201 | 2020-10-07 |
| Find all providers with the same taxonomy | ||||
| City | GRAND FORKS |
| Zip Code | 58201 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.