=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760911572
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEYAMMA MATHEW NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2017
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 941 E PARK ROW DR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-522-0221
-----------------------------------------------------
Fax | 817-522-0401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 941 E PARK ROW DR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-522-0221
-----------------------------------------------------
Fax | 817-522-0401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP133700
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------