Provider Demographics
NPI:1164469185
Name:MATHEWS, CRIS ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:CRIS
Middle Name:ANN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6200
Mailing Address - Country:US
Mailing Address - Phone:605-718-5123
Mailing Address - Fax:605-719-9509
Practice Address - Street 1:240 MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6200
Practice Address - Country:US
Practice Address - Phone:605-718-5123
Practice Address - Fax:605-719-9509
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6822032Medicaid
970023738Medicare ID - Type UnspecifiedRAILROAD MEDICARE
R02531Medicare UPIN
SD8483Medicare ID - Type Unspecified