Provider Demographics
NPI:1538282389
Name:MATHEW, JIBY PAUL (FNP)
Entity type:Individual
Prefix:
First Name:JIBY
Middle Name:PAUL
Last Name:MATHEW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 WARREN PKWY
Mailing Address - Street 2:STE 160
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4169
Mailing Address - Country:US
Mailing Address - Phone:972-668-5400
Mailing Address - Fax:972-668-5401
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:STE 160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:972-668-5400
Practice Address - Fax:972-668-5401
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD07564OtherMEDICARE RR PALMETTO
TXDQ5280OtherMEDICARE RR PALMETTO
TX207573101Medicaid
TX207573102Medicaid
TXD07564OtherMEDICARE RR PALMETTO
TXDQ5280OtherMEDICARE RR PALMETTO
TX207573101Medicaid