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

Mallory Elizabeth Boggs, A-GNP-C

Individual provider Primary Care Nurse Practitioner · NPI 1013543388

Mallory Elizabeth Boggs, A-GNP-C is a Nurse Practitioner in Madison, Mississippi. Qualified in 2017, 9 years ago. Practices with Fountains of Richmond LLC, a 2-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
9
Licensed in
MS
In the registry since
2020

Practice location Address checks out

159 Fountains Blvd Ste B
Madison, MS 39110-6344
Phone: (601) 859-8200
Show map & directions

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

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence 903821 (MS)

Record details

NPI number1013543388
Entity typeIndividual (Type 1)
GenderFemale
Credentials A-GNP-C
Sole proprietorNo
NPI enumeratedMarch 19, 2020
Last updated in NPPESMarch 19, 2020
Certification dateMarch 19, 2020

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Fountains Of Richmond Llc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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