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Mallory Ann Hoskins

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

(704) 495-6036 (704) 918-1934

PECOS Enrollment

This provider is enrolled in PECOS as MALLORY HOSKINS.

Based on the most recent information from CMS, provider Mallory Ann Hoskins is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 34 days ago.

Profile Details

Provider ID
1811550197
Provider Type
Individual
Full Name
Hoskins, Mallory Ann
Credential
PA

Gender
Female
Sole Proprietor
No
Enumeration Date
4/22/2019
Last Updated
3/12/2024

Contact Information

Practice Location

16817 Marvin Rd, Charlotte, NC 28277

(704) 495-6036

Unlisted Fax

Mailing Location

5960 Fairview Rd Ste 500, Charlotte, NC 28210-3113

(704) 918-1934

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 0010-13784 North Carolina
Code 174400000X	Description Specialist Other Service Providers	License 4209 South Carolina
Code 207N00000X	Description Dermatology Allopathic & Osteopathic Physicians	License 4209 South Carolina
Code 207N00000X	Description Dermatology Allopathic & Osteopathic Physicians	License 2381 Nebraska
Code 363AM0700X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 4209 South Carolina

Provider Identifiers

ID	Description	Issuer
ID $$$$$$$$$	Description Medicaid	Issuer Unlisted South Carolina

Mallory Ann Hoskins

PECOS Enrollment

Profile Details

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