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NPI Code Detail

MEDICARE: GWENDOLYN MATHIS DNP-APRN

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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner20988TN
2363LF0000XFamily Nurse Practitioner20988TN
3363L00000XNurse Practitioner20988TN
4363LP0808XPsychiatric/Mental Health Nurse Practitioner249010AZ
5363LP0808XPsychiatric/Mental Health Nurse Practitioner834633NY
6363LP2300XPrimary Care Nurse PractitionerF0116574TN
7363LF0000XFamily Nurse Practitioner1142764TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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 : 4635 S LAKESHORE DR # 314
Second Line :
City : TEMPE
State : AZ
Zip : 85282-7127
Country : US
Telephone Number : 802-287-6030
Fax Number : 602-584-6216
Provider Business Practice Location Address
First Line : 4203 S CARRIER PKWY
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75052-3203
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 : 03/17/2026

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