Healthcare Provider Details

I. General information

NPI: 1538603600
Provider Name (Legal Business Name): SHAWNA MATHIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 GREENTREE N
CLARKSVILLE IN
47129-8957
US

IV. Provider business mailing address

PO BOX 7020
JEFFERSONVILLE IN
47131-7020
US

V. Phone/Fax

Practice location:
  • Phone: 812-283-4441
  • Fax: 812-288-2605
Mailing address:
  • Phone: 812-285-5983
  • Fax: 812-280-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28168470A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: