MRS. MALLORY MOODY PUTNAM PA
NPI 1336493428
Physician Assistant - Medical in Lakeland, FL

Q: What is Mallory Putnam's NPI number?

The NPI number for Mallory Putnam is 1336493428. It was assigned to this individual provider in the NPPES registry on October 29, 2012.

Q: What is Mallory Putnam's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Mallory Putnam was last updated on January 30, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 29, 2012PECOS Enrolled

2615 FAIRMOUNT AVE, LAKELAND, FL 33803(863) 661-3887 Get Directions Write a Review

NPPES record last updated: January 30, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Mrs. Mallory Moody Putnam Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. MALLORY MOODY PUTNAM PA (NPI 1336493428) is an individual medical provider in Lakeland, Florida, licensed in Florida (PA9106745) and active in the NPI registry since October 2012. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1336493428

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameMRS. MALLORY MOODY PUTNAMCredential: PA

Location Address2615 FAIRMOUNT AVELakeland, FL 33803-3159

Mailing Address1324 Lakeland Hills BlvdLakeland, FL 33805-4543 · (863) 687-1100

Phone(863) 661-3887

Sole ProprietorYes

Enumeration DateOctober 29, 2012

Last NPPES UpdateJanuary 30, 2017

✔ NPI 1336493428 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in FL · PA9106745

2615 FAIRMOUNT AVE, Lakeland, FL 33803

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Mallory Moody Putnam Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mallory Putnam's NPI number?

The NPI number for Mallory Putnam is 1336493428. It was assigned to this individual provider in the NPPES registry on October 29, 2012.

Where is Mallory Putnam located?

Mallory Putnam practices at 2615 Fairmount Ave, Lakeland, FL 33803. The listed phone number is (863) 661-3887.

What is Mallory Putnam's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Mallory Putnam enrolled in Medicare?

Yes. Mallory Putnam is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mallory Putnam was last updated on January 30, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.