MEDICARE: MERIN MATHEW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	PA19224	TX
3	363L00000X	Nurse Practitioner	PA19224	TX

General Provider Information

NPI Number	:	1427863802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERIN MATHEW

Provider Business Mailing Address
First Line	:	4729 PARADISE CV
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-7296
Country	:	US
Telephone Number	:	469-407-0336
Fax Number	:

Provider Business Practice Location Address
First Line	:	4729 PARADISE CV
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-7296
Country	:	US
Telephone Number	:	469-407-0336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	04/06/2026

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Directions to “ MERIN MATHEW ” Practice Location

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