Provider Demographics
NPI:1275905465
Name:MATHIS, LISA JETT (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JETT
Last Name:MATHIS
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:3021 REIDVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301
Mailing Address - Country:US
Mailing Address - Phone:864-576-9201
Mailing Address - Fax:864-576-6584
Practice Address - Street 1:3021 REIDVILLE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5643
Practice Address - Country:US
Practice Address - Phone:864-576-9201
Practice Address - Fax:864-576-6584
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC19722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily