Healthcare Provider Details

I. General information

NPI: 1992628267
Provider Name (Legal Business Name): MITCHELL SCOTT MATHES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 N ELLINGTON PKWY
LEWISBURG TN
37091-2217
US

IV. Provider business mailing address

402 KELSO MULBERRY RD
MULBERRY TN
37359-5106
US

V. Phone/Fax

Practice location:
  • Phone: 931-359-4555
  • Fax:
Mailing address:
  • Phone: 931-922-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number195714
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number195714
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: