Provider Demographics
NPI:1861941619
Name:MATTHEWS, KELLY ELEANOR MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ELEANOR MARIE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3638 E SOUTHERN AVE
Mailing Address - Street 2:STE C108
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2563
Mailing Address - Country:US
Mailing Address - Phone:480-834-0771
Mailing Address - Fax:480-834-1136
Practice Address - Street 1:3638 E SOUTHERN AVE
Practice Address - Street 2:STE C108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2563
Practice Address - Country:US
Practice Address - Phone:480-834-0771
Practice Address - Fax:480-834-1136
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP8991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP8991OtherLICENSE