Provider Demographics
NPI:1255865382
Name:MATHEWSON, KRISTYN (DO, MPH, MS)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:MATHEWSON
Suffix:
Gender:F
Credentials:DO, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SAINT MICHAEL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5211
Mailing Address - Country:US
Mailing Address - Phone:903-614-5372
Mailing Address - Fax:903-614-7665
Practice Address - Street 1:2020 SUNDANCE PKWY STE A1
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2771
Practice Address - Country:US
Practice Address - Phone:830-625-7748
Practice Address - Fax:830-625-2563
Is Sole Proprietor?:No
Enumeration Date:2017-04-15
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR8606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1G7417OtherMEDICARE
TXP02587338OtherMEDICARE RAILROAD
TXPENDINGMedicaid