MEDICARE: KELSEY MARIAH MATTHEWS PA

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	363A00000X	Physician Assistant	2883	TN
2	363A00000X	Physician Assistant	2602	SC
3	363A00000X	Physician Assistant	50.008581RX	OH

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	:	1518330323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY MARIAH MATTHEWS PA

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT STE 212
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4536
Country	:	US
Telephone Number	:	864-797-6308
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 KETTERING WAY STE 100
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-1155
Country	:	US
Telephone Number	:	937-746-8357
Fax Number	:

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

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/19/2024

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Directions to “ KELSEY MARIAH MATTHEWS PA” Practice Location

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