MALLORY RICH SHATLOCK NURSE PRACTITIONER
NPI 1548728249
Nurse Practitioner in Winston Salem, NC

Q: What is Mallory Shatlock's NPI number?

The NPI number for Mallory Shatlock is 1548728249. It was assigned to this individual provider in the NPPES registry on March 12, 2019.

Q: What is Mallory Shatlock's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Mallory Shatlock was last updated on December 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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 March 12, 2019PECOS EnrolledAccepts Medicare Assignment

190 KIMEL PARK DR STE 155, WINSTON SALEM, NC 27103(336) 765-6637(336) 765-6964 Get Directions Write a Review

NPPES record last updated: December 30, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 30, 2024, Nov 7, 2024, Dec 16, 2022 and 2 more (5 updates tracked since 2019).

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About Mallory Rich Shatlock Nurse Practitioner NPPES

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

MALLORY RICH SHATLOCK NURSE PRACTITIONER (NPI 1548728249) is an individual nurse practitioner in Winston Salem, North Carolina, licensed in North Carolina (5021115) and active in the NPI registry since March 2019. She is enrolled in Medicare PECOS, is affiliated with Novant Health Forsyth Medical Center, and maintains a secondary practice location in Birmingham.

NPPES Registry Identity

NPI1548728249

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameMALLORY RICH SHATLOCKCredential: NURSE PRACTITIONER

Location Address190 KIMEL PARK DR STE 155Winston Salem, NC 27103-6946

Mailing AddressPo Box 60447Charlotte, NC 28260-0447 · (336) 765-6637 · Fax (336) 765-6964

Phone(336) 765-6637

Fax(336) 765-6964

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateMarch 12, 2019

Last NPPES UpdateDecember 30, 20245 updates tracked since enumeration

NPPES CertifiedDecember 30, 2024

✔ NPI 1548728249 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in NC · 5021115

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License 1-159191 (AL)

190 KIMEL PARK DR STE 155, Winston Salem, NC 27103

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Secondary Practice Location 1

Location 13535 Grandview Pkwy Ste 150Birmingham, AL 35243-2027 · Phone (205) 250-6805

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mallory Rich Shatlock Nurse Practitioner is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6507276284

PECOS Enrollment IDI20250107001103

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Novant Health Forsyth Medical Center

Acute Care Hospitals · Winston-Salem, NC

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number340014

Location3333 Silas Creek ParkwayWinston-Salem, NC 27103 · Forsyth County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27103 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.90 typical visit price

range $54.12 – $165.09

Typical copayment $20.97 (range $13.53 – $41.27)

Most-billed visit code 99203

Established Patient

$95.94 typical visit price

range $17.21 – $134.61

Typical copayment $23.98 (range $4.30 – $33.65)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHELLE ELIZABETH DE WITT M.D.

Neurological Surgery