Healthcare Provider Details

I. General information

NPI: 1255865382
Provider Name (Legal Business Name): KRISTYN MATHEWSON D.O., M.P.H., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2017
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SUNDANCE PKWY STE A1
NEW BRAUNFELS TX
78130-2771
US

IV. Provider business mailing address

2900 SAINT MICHAEL DR STE 401
TEXARKANA TX
75503-5211
US

V. Phone/Fax

Practice location:
  • Phone: 830-625-7748
  • Fax: 830-625-2563
Mailing address:
  • Phone: 903-614-5372
  • Fax: 903-614-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: