Provider Demographics
NPI:1083615876
Name:MATTHEWS CHRISTOPHER, KIMBERLY DIANE (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DIANE
Last Name:MATTHEWS CHRISTOPHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DIANE
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0780
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 VAN VOORHIS RD STE 100
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3587
Practice Address - Country:US
Practice Address - Phone:304-598-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-275195-L367500000X
WV37117367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV27005299700OtherWORKERS COMP
WV27005299701OtherWORKERS COMP
WVP00299102OtherRR MEDICARE
WV270052997004OtherTRICARE
WV0207026000Medicaid
WV3810002301Medicaid
WV001747843OtherMSBCBS
WV001706470OtherMSBCBS
WVDA0096OtherRR MEDICARE
WV27005299701OtherWORKERS COMP
WVP00299102OtherRR MEDICARE
WV27005299701OtherWORKERS COMP