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General NPI Number Information
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NPI Number | 1518330323
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Entity Type | Individual
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Provider Name | KELSEY MARIAH MATTHEWS PA
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Gender | Female
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 100 KETTERING WAY STE 100
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City | FRANKLIN
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State | OH
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Zip | 45005-1155
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Country | US
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Telephone | 937-746-8357
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Fax |
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Provider Business Mailing Address
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Address Line | 1 INDEPENDENCE PT STE 212
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City | GREENVILLE
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State | SC
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Zip | 29615-4536
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Country | US
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Telephone | 864-797-6308
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2883
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2602
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.008581RX
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License Number State | OH
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