MEDICARE: KAITLYN CONNOR MATHENEY APRN

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	363LF0000X	Family Nurse Practitioner	28406	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689242463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN CONNOR MATHENEY APRN

Provider Business Mailing Address
First Line	:	160 AUTUMN AVE
Second Line	:
City	:	FREEPORT
State	:	FL
Zip	:	32439-4250
Country	:	US
Telephone Number	:	270-508-0745
Fax Number	:

Provider Business Practice Location Address
First Line	:	5551 US HIGHWAY 98 W
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-3566
Country	:	US
Telephone Number	:	205-565-1232
Fax Number	:

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

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	02/21/2023

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