=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518841659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTA NANDRA MATHURIN FNP STUDENT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2025
-----------------------------------------------------
Last Update Date | 12/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 KARA CT
-----------------------------------------------------
City | RINEYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40162-9429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-399-0968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6923 LA VALLEE
-----------------------------------------------------
City | KINGSHILL
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00850-9923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-399-0968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | 14000
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN9535834
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------