Provider Demographics
NPI:1417667445
Name:MATHIAS, CHASITY (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:MATHIAS
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 1:5595 ASHBYBURG RD
Mailing Address - Street 2:
Mailing Address - City:SLAUGHTERS
Mailing Address - State:KY
Mailing Address - Zip Code:42456-9676
Mailing Address - Country:US
Mailing Address - Phone:270-339-0320
Mailing Address - Fax:
Practice Address - Street 1:5595 ASHBYBURG RD
Practice Address - Street 2:
Practice Address - City:SLAUGHTERS
Practice Address - State:KY
Practice Address - Zip Code:42456-9676
Practice Address - Country:US
Practice Address - Phone:270-339-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018583282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural