Healthcare Provider Details

I. General information

NPI: 1659084390
Provider Name (Legal Business Name): ALEYAMMA MATHEWS AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

IV. Provider business mailing address

9113 FLOYD DR
PLANO TX
75025-5177
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-7700
  • Fax:
Mailing address:
  • Phone: 251-333-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1094525
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: