=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932727625
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATI MATHIS APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2020
-----------------------------------------------------
Last Update Date | 04/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2104A WOODRUFF RD
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29607-5941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-336-2323
-----------------------------------------------------
Fax | 864-236-4222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2255 GLADES RD STE 228W
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-7391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-342-8829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 25306
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------