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

Mallory Gauthier, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1598277907

Mallory Gauthier, PHYSICIANASSISTANT is a Physician Assistant in Carbondale, Illinois. Graduated from Southern Illinois University School of Medicine in 2017, 9 years ago. Licensed in Illinois.

Years since qualifying
9
Trained at
Southern Illinois University School of Medicine
Licensed in
IL
In the registry since
2017
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Practice location Address checks out

207 W Jackson St Ste 201
Carbondale, IL 62901-1408
Phone: (618) 457-2963
Fax: (618) 457-2992
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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 085006422 (IL)

Record details

NPI number1598277907
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedOctober 26, 2017
Last updated in NPPESApril 20, 2026
Certification dateApril 20, 2026
Mailing address207 W Jackson St Ste 201, Carbondale, IL 62901-1408

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolSOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Not indicated

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