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Individual
KRISTIE MALLOY
Active
Individual
KRISTIE MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00943500
NJ
363A00000X
Physician Assistant
MA056898
PA
363AM0700X
Medical Physician Assistant
MA056898
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103143340
—
PA
Enumeration date
06/13/2014
Last updated
09/24/2025
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