Healthcare Provider Details

I. General information

NPI: 1174400725
Provider Name (Legal Business Name): KATHRYN MATHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 EMERSON AVE
PARKERSBURG WV
26104-2519
US

IV. Provider business mailing address

2910 EMERSON AVE
PARKERSBURG WV
26104-2519
US

V. Phone/Fax

Practice location:
  • Phone: 304-239-5355
  • Fax: 304-239-5355
Mailing address:
  • Phone: 304-239-5355
  • Fax: 304-239-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number23-9195
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: