Provider Demographics
NPI:1366478182
Name:MALLET, MARYRITA KAISER (MD PA)
Entity Type:Individual
Prefix:MRS
First Name:MARYRITA
Middle Name:KAISER
Last Name:MALLET
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1976
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-7976
Mailing Address - Country:US
Mailing Address - Phone:817-613-1942
Mailing Address - Fax:817-341-3882
Practice Address - Street 1:116 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6548
Practice Address - Country:US
Practice Address - Phone:817-613-1942
Practice Address - Fax:817-341-3882
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ43222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0962482-03Medicaid
TX00609VMedicare ID - Type Unspecified
TX0962482-03Medicaid