Provider Demographics
NPI:1841765351
Name:MADDOX, MALLORY HOPE (PA-C)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:HOPE
Last Name:MADDOX
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SH 121 BYP
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8119
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:
Practice Address - Street 1:700 SH 121 BYP
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8119
Practice Address - Country:US
Practice Address - Phone:972-745-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111377363A00000X
TXPA13196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant