Healthcare Provider Details

I. General information

NPI: 1124763669
Provider Name (Legal Business Name): PRIYA J MATHUR FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 HEALTH CARE DR
ROCK HILL SC
29732-3858
US

IV. Provider business mailing address

5016 BLAKE CATHERINE CT
CHARLOTTE NC
28205-7198
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-7772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number25989
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: