Provider Demographics
NPI:1043796014
Name:MATHIS, CHARITY A (DNP)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:A
Last Name:MATHIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 HORNERS SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:GERRARDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25420-4276
Mailing Address - Country:US
Mailing Address - Phone:561-271-9244
Mailing Address - Fax:
Practice Address - Street 1:1115 HORNERS SAWMILL RD
Practice Address - Street 2:
Practice Address - City:GERRARDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25420-4276
Practice Address - Country:US
Practice Address - Phone:561-271-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV111213363LF0000X, 363LP0808X
VA0024183967363LF0000X, 363LP0808X
MDAC007262363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily