Provider Demographics
NPI:1427226877
Name:MATSON, KATHRYN S (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:MATSON
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:MAIN 9 NORTHWEST
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-823-7558
Mailing Address - Fax:617-730-0899
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:MAIN 9 NORTHWEST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-823-7558
Practice Address - Fax:617-730-0899
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237538363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics