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

Mallori Wisuri Hathaway, PA-C

Individual provider Physician Assistant · NPI 1861019689

Mallori Wisuri Hathaway, PA-C is a Physician Assistant in Scottsburg, Indiana. Qualified in 2021, 5 years ago. Practices with Forefront Dermatology SC, a 645-clinician group, works from 8 locations and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
5
Licensed in
IN
In the registry since
2020
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

1428 N Gardner St
Scottsburg, IN 47170-8720
Phone: (812) 752-3512
Fax: (812) 752-8593
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (7)

  • 415 S Landmark Ave, Bloomington, IN 47403-5003 — (812) 333-7433
  • 244 Westwood Blvd, Columbus, IN 47201-5687 — (812) 669-0141
  • 1263 Hospital Dr Nw Ste 100, Corydon, IN 47112-2173 — (812) 783-2054
  • 2130 W Sycamore St Ste 200, Kokomo, IN 46901-6461 — (765) 457-4455
  • 505 W Homer St Ste 201, Salem, IN 47167-1698 — (812) 883-0024
  • 911 N Shelby St, Salem, IN 47167-2304 — (812) 883-8527
  • 303 S Walnut St, Seymour, IN 47274-2368 — (812) 358-7705

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10003222A (IN)

Record details

NPI number1861019689
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 27, 2020
Last updated in NPPESNovember 12, 2025
Certification dateNovember 12, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Forefront Dermatology Sc — 645 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

Other providers in Scottsburg