MEDICARE: MALLORY CLAIR POYNTER PA-C

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	363AS0400X	Surgical Physician Assistant	PA09558	TX
2	363AS0400X	Surgical Physician Assistant	PA3172	KY
3	363AS0400X	Surgical Physician Assistant	2969	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2969	OTHER	CT	PA LICENSE
2	PA09558	OTHER	TX	TEXAS PHYSICIAN ASSISTANT LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659703007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY CLAIR POYNTER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 936
Second Line	:
City	:	LONDON
State	:	KY
Zip	:	40743-0936
Country	:	US
Telephone Number	:	606-330-7835
Fax Number	:	606-330-7825

Provider Business Practice Location Address
First Line	:	160 N EAGLE CREEK DR STE 201
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2125
Country	:	US
Telephone Number	:	859-967-5520
Fax Number	:	859-967-5444

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	03/04/2026

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Directions to “ MALLORY CLAIR POYNTER PA-C” Practice Location

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