Mallori Wisuri Hathaway, PA-C is a medicare enrolled "Physician Assistant" in Scottsburg, Indiana. She graduated from nursing school in 2021 and has 3 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice Forefront Dermatology and her current practice location is
1428 N Gardner St, Scottsburg, Indiana. You can reach out to her office (for appointments etc.) via phone at
(812) 752-3512.
Mallori Wisuri Hathaway is licensed to practice in Indiana (license number 10003222A) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1861019689.
Provider's Profile
Full Name | Mallori Wisuri Hathaway |
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Gender | Female |
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Speciality | Physician Assistant |
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Experience | 3 Years |
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Location | 1428 N Gardner St, Scottsburg, Indiana |
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Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Medical Education and Training:
- Mallori Wisuri Hathaway graduated from nursing school in 2021
NPI Data:
- NPI Number: 1861019689
- Provider Enumeration Date: 06/27/2020
- Last Update Date: 09/17/2021
Medicare PECOS Information:
- PECOS PAC ID: 5294143251
- Enrollment ID: I20210413001214
Medical Identifiers
Medical identifiers for Mallori Wisuri Hathaway such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1861019689 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363A00000X | Physician Assistant | 10003222A (Indiana) | Primary |
Group Practice Association
Group Practice Name | Group PECOS PAC ID | No. of Members |
Forefront Dermatology | 3779471701 | 474 |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mallori Wisuri Hathaway is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mallori Wisuri Hathaway, PA-C 801 York St, Manitowoc, WI 54220-4630 Ph: (920) 663-9008 | Mallori Wisuri Hathaway, PA-C 1428 N Gardner St, Scottsburg, IN 47170-8720 Ph: (812) 752-3512 |
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