MEDICARE: MRS. MARYRITA K MALLET MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	J4322	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366478182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYRITA K MALLET MD

Provider Business Mailing Address
First Line	:	PO BOX 1976
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-7976
Country	:	US
Telephone Number	:	817-613-1942
Fax Number	:	817-341-3882

Provider Business Practice Location Address
First Line	:	PO BOX 1976
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-7976
Country	:	US
Telephone Number	:	817-613-1942
Fax Number	:	817-341-3882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	05/06/2026

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