Healthcare Provider Details

I. General information

NPI: 1821493446
Provider Name (Legal Business Name): CAROL F MATTISON DNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6029 WALNUT GROVE RD STE 250
MEMPHIS TN
38120-2112
US

IV. Provider business mailing address

475 COLONIAL RD
MEMPHIS TN
38117-4016
US

V. Phone/Fax

Practice location:
  • Phone: 901-685-3490
  • Fax: 901-685-3499
Mailing address:
  • Phone: 901-568-3729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number119039
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN0000028051
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: