Individual ProviderMallory PuckettNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address4143 Fulton Dr NW, Canton, OH 44718-2819(330) 244-8888(740) 381-2826PECOS EnrollmentBased on the most recent information from CMS, provider Mallory Puckett is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1447753520Provider TypeIndividualFull NamePuckett, MalloryCredentialCNPGenderFemaleSole ProprietorNoEnumeration Date3/14/2018Last Updated10/23/2025Contact InformationPractice LocationPractice Address4143 Fulton Dr NW, Canton, OH 44718-2819Phone(330) 244-8888Fax(330) 244-8850Mailing LocationMailing Address2718 Ridgewood Ave, Alliance, OH 44601-4810Phone(740) 381-2826FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAPRN.CNP.022510OhioProvider IdentifiersIDDescriptionIssuerIDAPRN.CNP.022510DescriptionOtherIssuerOHELICENSEOhioID0289079DescriptionMedicaidIssuerUnlistedOhio