Healthcare Provider Details

I. General information

NPI: 1073697694
Provider Name (Legal Business Name): KATHARINE M MATTHIS RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/28/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 NORTH MAIN STREET
SAINT REGIS FALLS NY
12980
US

IV. Provider business mailing address

214 KING ST
OGDENSBURG NY
13669-1142
US

V. Phone/Fax

Practice location:
  • Phone: 518-481-8460
  • Fax:
Mailing address:
  • Phone: 315-393-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006534
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006534
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number006534
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number006534-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: