Healthcare Provider Details

I. General information

NPI: 1174436760
Provider Name (Legal Business Name): JOHN THOMAS MATTISON PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 E NARDINI ST
SAN TAN VALLEY AZ
85140-7726
US

IV. Provider business mailing address

842 E NARDINI ST
SAN TAN VALLEY AZ
85140-7726
US

V. Phone/Fax

Practice location:
  • Phone: 928-301-4549
  • Fax:
Mailing address:
  • Phone: 928-301-4549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number233327
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: