Healthcare Provider Details

I. General information

NPI: 1063323236
Provider Name (Legal Business Name): ELIZABETH KAREN MATTHEWS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

681 W SPRING VALLEY PIKE
DAYTON OH
45458-3618
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8000
  • Fax:
Mailing address:
  • Phone: 937-308-0217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberLE-00065511
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: