Provider Demographics
NPI:1184223786
Name:MATHEW, VINCY (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:VINCY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E LAMAR BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:612 E LAMAR BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4126
Practice Address - Country:US
Practice Address - Phone:817-250-2000
Practice Address - Fax:682-708-7225
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017721363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care