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

Individual provider Surgery Physician · NPI 1487309290

Miranda Mallicoat is a Surgery Physician in Louisville, Kentucky. Practices as a sole proprietor and works from 2 locations. Licensed in Kentucky.

Licensed in
KY
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

3900 Kresge Way Ste 51
Louisville, KY 40207-4683
Phone: (502) 259-5955
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1919 State St Ste 250, New Albany, IN 47150-6805 — (812) 949-5933

Specialties & licences

Surgical Assistant (primary) Taxonomy 246ZC0007X · Licence TSA026 (KY)
Surgery Physician Taxonomy 208600000X · Licence TSA026 (KY)

Record details

NPI number1487309290
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedFebruary 21, 2022
Last updated in NPPESMarch 9, 2022
Certification dateMarch 9, 2022

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