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NPI Code Detail

MEDICARE: MR. LESLIE A. MATHEWSON APN (PMHNP)

MEDICARE: MR. LESLIE A. MATHEWSON APN (PMHNP)
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
1363L00000XNurse Practitioner142095TN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner10492TN
3363L00000XNurse Practitioner25390SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13648105OTHERTNMEDICARE ID TYPE UNSPECIFIED

General Provider Information

NPI Number : 1376588236
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LESLIE A. MATHEWSON APN (PMHNP)
Provider Business Mailing Address
First Line : 10434 JACKSON OAKS WAY
Second Line :
City : KNOXVILLE
State : TN
Zip : 37922-3293
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10434 JACKSON OAKS WAY
Second Line :
City : KNOXVILLE
State : TN
Zip : 37922-3293
Country : US
Telephone Number : 865-281-1408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2006
Last Update Date : 06/28/2023

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