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

MS. Mallory Deanne Fairweather, PA-C

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1770224438

MS. Mallory Deanne Fairweather, PA-C is a Physician Assistant in Fayetteville, North Carolina. Qualified in 2022, 4 years ago. Practices with Id Care(r) - Infectious Diseases Specialty Practice PA, a 10-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
4
Licensed in
NC
In the registry since
2022
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

Student / training record This NPI belongs to someone enrolled in a health care training programme. It carries no licence and no practice of its own, so no address or phone number is published for it.

Fayetteville, NC

Additional practice locations (1)

  • 4350 Us 421 S, Lillington, NC 27546-6760 — (910) 893-1210

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X (NC)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1770224438
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 6, 2022
Last updated in NPPESAugust 11, 2025
Certification dateAugust 11, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Id Care(R) - Infectious Diseases Specialty Practice Pa — 10 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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