Healthcare Provider Details

I. General information

NPI: 1073148540
Provider Name (Legal Business Name): JENNIFER THIM OUNG MATHURIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PEARL ST # 1600A
BROCKTON MA
02301-2864
US

IV. Provider business mailing address

1 PEARL ST # 1600A
BROCKTON MA
02301-2864
US

V. Phone/Fax

Practice location:
  • Phone: 617-924-6484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2318611
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRN2318611
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2318611
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: