Provider Demographics
NPI:1275169724
Name:MATHEW, BINCY (APRN)
Entity Type:Individual
Prefix:
First Name:BINCY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:BINCY
Other - Middle Name:
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:2552 ELDORADO PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-8629
Mailing Address - Country:US
Mailing Address - Phone:469-495-9114
Mailing Address - Fax:
Practice Address - Street 1:2552 ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8629
Practice Address - Country:US
Practice Address - Phone:469-495-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX774689163WE0003X
TXAP145454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP145454OtherAPRN
TX774689OtherREGISTERED NURSE