Provider Demographics
NPI:1043796014
Name:MATHIS, CHARITY A (DNP)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:A
Last Name:MATHIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8812 COSTIN LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-1509
Mailing Address - Country:US
Mailing Address - Phone:561-271-9244
Mailing Address - Fax:
Practice Address - Street 1:4109 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-2703
Practice Address - Country:US
Practice Address - Phone:410-609-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV111213363LF0000X, 363LP0808X
VA0024183967363LF0000X, 363LP0808X
MDR220902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health