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

Individual provider Medical Physician Assistant · NPI 1336493428

Mrs. Mallory Moody Putnam, PA is a Medical Physician Assistant in Lakeland, Florida. Practices as a sole proprietor. Licensed in Florida.

Licensed in
FL
In the registry since
2012
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

2615 Fairmount Ave
Lakeland, FL 33803-3159
Phone: (863) 661-3887
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA9106745 (FL)

Record details

NPI number1336493428
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorYes
NPI enumeratedOctober 29, 2012
Last updated in NPPESJanuary 30, 2017

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