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  7. NPI Record 1467978403

MALLORY STEPHENS TATUM P.A.
Complete NPI Record 1467978403
Physician Assistant in Lakeland, TN

NPI Status: Active since August 22, 2017

Contact Information

9160 HIGHWAY 64 STE 105
LAKELAND, TN
ZIP 38002
Phone: (901) 213-0100
Fax: (901) 213-0101

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider Other Last Name
  8. Provider Other First Name
  9. Provider Other Last Name Type Code
  10. Provider First Line Business Mailing Address
  11. Provider Business Mailing Address City Name
  12. Provider Business Mailing Address State Name
  13. Provider Business Mailing Address Postal Code
  14. Provider Business Mailing Address Country Code If outside U S
  15. Provider Business Mailing Address Telephone Number
  16. Provider First Line Business Practice Location Address
  17. Provider Business Practice Location Address City Name
  18. Provider Business Practice Location Address State Name
  19. Provider Business Practice Location Address Postal Code
  20. Provider Business Practice Location Address Country Code If outside U S
  21. Provider Business Practice Location Address Telephone Number
  22. Provider Business Practice Location Address Fax Number
  23. Provider Enumeration Date
  24. Last Update Date
  25. Provider Gender Code
  26. Healthcare Provider Taxonomy Code 1
  27. Provider License Number 1
  28. Provider License Number State Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Is Sole Proprietor
  31. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1467978403. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1467978403
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: MALLORY
The first name of the provider, if the provider is an individual.
Provider Middle Name: STEPHENS
The middle name of the provider, if the provider is an individual.
Provider Credential Text: P.A.
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Other Last Name: STEPHENS
Other last name by which the provider being identified is or has been known.
Provider Other First Name: MALLORY
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only.
Provider Other Last Name Type Code: 1
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 8016 ELLIS RD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: BARTLETT
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: TN
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 381332806
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 6623229442
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 9160 HIGHWAY 64 STE 105
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Business Practice Location Address City Name: LAKELAND
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Business Practice Location Address State Name: TN
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 380023011
The first name of the provider, if the provider is an individual.
Provider Business Practice Location Address Country Code If outside U S : US
The middle name of the provider, if the provider is an individual.
Provider Business Practice Location Address Telephone Number: 9012130100
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Business Practice Location Address Fax Number: 9012130101
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Enumeration Date: 8/22/2017
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Last Update Date: 3/26/2020
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 363A00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 3352
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: TN
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Healthcare Provider Primary Taxonomy Switch 1: Y
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Is Sole Proprietor: N
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
NPI Certification Date: 3/26/2020