Provider Demographics
NPI:1881081347
Name:MCKING, MALLORY ANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ANNE
Last Name:MCKING
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8051 S EMERSON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8632
Mailing Address - Country:US
Mailing Address - Phone:317-865-2955
Mailing Address - Fax:317-859-2701
Practice Address - Street 1:ROUDEBUSH VA MEDICAL CENTER
Practice Address - Street 2:1481 W 10TH ST
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-988-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2020-03-04
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant