MEDICARE: GWENDOLYN MATHIS DNP-APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	834633	NY
2	363LF0000X	Family Nurse Practitioner	20988	TN
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	249010	AZ
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20988	TN
5	363LF0000X	Family Nurse Practitioner	1142764	TX
6	363L00000X	Nurse Practitioner	20988	TN
7	363LP2300X	Primary Care Nurse Practitioner	F0116574	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194183137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN MATHIS DNP-APRN

Provider Business Mailing Address
First Line	:	315 W ELLIOT RD STE 107-149
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1328
Country	:	US
Telephone Number	:	802-287-6030
Fax Number	:	602-584-6216

Provider Business Practice Location Address
First Line	:	325 NORTH DR STE 3100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-4431
Country	:	US
Telephone Number	:	802-287-6030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	10/29/2025

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