Healthcare Provider Details

I. General information

NPI: 1053846212
Provider Name (Legal Business Name): LINDSEY MATHES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 BETHEL REED PARK STE 100
COLUMBUS OH
43220-1818
US

IV. Provider business mailing address

156 DELAND AVE
COLUMBUS OH
43214-3024
US

V. Phone/Fax

Practice location:
  • Phone: 252-649-9636
  • Fax: 614-670-5742
Mailing address:
  • Phone: 252-649-9636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86028422
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND13555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: