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General NPI Number Information
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NPI Number | 1184080012
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Entity Type | Individual
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Provider Name | KELLY MATTHAEI AGPCNP-BC, ACCNS
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Gender | Female
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 7901 FROST ST
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City | SAN DIEGO
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State | CA
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Zip | 92123-2701
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Country | US
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Telephone | 858-761-2421
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Fax |
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Provider Business Mailing Address
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Address Line | 16309 OAKLEY RD
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City | RAMONA
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State | CA
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Zip | 92065-4231
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Country | US
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Telephone | 760-310-9145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number | 4267
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95002101
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License Number State | CA
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