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General NPI Number Information
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NPI Number | 1689242463
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Entity Type | Individual
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Provider Name | KAITLYN CONNOR MATHENEY APRN
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Gender | Female
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 5551 US HIGHWAY 98 W
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-3566
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Country | US
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Telephone | 205-565-1232
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Fax |
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Provider Business Mailing Address
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Address Line | 160 AUTUMN AVE
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City | FREEPORT
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State | FL
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Zip | 32439-4250
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Country | US
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Telephone | 270-508-0745
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28406
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License Number State | TN
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