Healthcare Provider Details

I. General information

NPI: 1558852301
Provider Name (Legal Business Name): MS. PAMELA J MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2018
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 MAIN ST STE 1
BOURNE MA
02532-3285
US

IV. Provider business mailing address

61 SPRING ST APT 1
PLAINVILLE MA
02762-1966
US

V. Phone/Fax

Practice location:
  • Phone: 508-743-5542
  • Fax:
Mailing address:
  • Phone: 317-498-9113
  • Fax: 774-272-8482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2303382
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2303382
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: