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

Mallory Rich Shatlock, NURSEPRACTITIONER

Individual provider Acute Care Nurse Practitioner · NPI 1548728249

Mallory Rich Shatlock, NURSEPRACTITIONER is a Nurse Practitioner in Winston Salem, North Carolina. Qualified in 2020, 6 years ago. Practices with Novant Health Medical Group, LLC, a 2,410-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Alabama and North Carolina.

Years since qualifying
6
Licensed in
AL, NC
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

190 Kimel Park Dr Ste 155
Winston Salem, NC 27103-6946
Phone: (336) 765-6637
Fax: (336) 765-6964
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3535 Grandview Pkwy Ste 150, Birmingham, AL 35243-2027 — (205) 250-6805

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 5021115 (NC)
Acute Care Nurse Practitioner Taxonomy 363LA2100X · Licence 1-159191 (AL)

Record details

NPI number1548728249
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorNo
NPI enumeratedMarch 12, 2019
Last updated in NPPESDecember 30, 2024
Certification dateDecember 30, 2024

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Novant Health Medical Group, Llc — 2410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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