MEDICARE: MRS. JOYCE KING MATHEWS

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	3747A0650X	Attendant Care Provider	NA08173249	TX

General Provider Information

NPI Number	:	1518516798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOYCE KING MATHEWS

Provider Business Mailing Address
First Line	:	6928 CLIPPER DR.
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054
Country	:	US
Telephone Number	:	682-518-5869
Fax Number	:	682-518-5869

Provider Business Practice Location Address
First Line	:	6928 CLIPPER DR.
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054
Country	:	US
Telephone Number	:	682-518-5869
Fax Number	:	682-518-5869

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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