Healthcare Provider Details

I. General information

NPI: 1699189829
Provider Name (Legal Business Name): NATHAN KIM MATTHEWS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

101 E WATERLOO ST
CANAL WINCHESTER OH
43110-1158
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-7500
  • Fax:
Mailing address:
  • Phone: 937-545-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.16008-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: