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General NPI Number Information
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NPI Number | 1417329129
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Entity Type | Individual
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Provider Name | SARAH JO MATA NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 1412 N 2ND ST
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City | ATCHISON
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State | KS
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Zip | 66002-1203
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Country | US
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Telephone | 913-367-4879
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Fax | 913-360-0240
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Provider Business Mailing Address
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Address Line | 1412 N 2ND ST
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City | ATCHISON
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State | KS
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Zip | 66002-1203
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Country | US
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Telephone | 913-367-4879
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Fax | 913-367-0240
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 76975
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License Number State | KS
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