Provider Demographics
NPI:1003206046
Name:MATHIS, ELIZABETH L (CNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:MATHIS
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-356-1256
Practice Address - Street 1:1248 KINNEYS LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2994
Practice Address - Country:US
Practice Address - Phone:740-365-7290
Practice Address - Fax:740-356-7938
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2023-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034195363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
15070756OtherCAQH
KY7100719560Medicaid