Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mallori Walters, PA

Individual provider Physician Assistant · NPI 1831556125

Mallori Walters, PA is a Physician Assistant in St Louis Park, Minnesota. Qualified in 2015, 11 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
11
Licensed in
MN
In the registry since
2016
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone: (952) 883-1000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 12110 (MN)

Record details

NPI number1831556125
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJanuary 19, 2016
Last updated in NPPESApril 2, 2020
Certification dateApril 2, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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