Healthcare Provider Details

I. General information

NPI: 1194796177
Provider Name (Legal Business Name): RACHEL A MATHERS RNC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 HEDRICK DR
NEWPORT TN
37821-2902
US

IV. Provider business mailing address

PO BOX 577
NEWPORT TN
37822-0577
US

V. Phone/Fax

Practice location:
  • Phone: 423-623-1057
  • Fax: 423-625-8620
Mailing address:
  • Phone: 423-613-3320
  • Fax: 423-623-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN140110
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN8426
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: