Provider Demographics
NPI:1437623113
Name:MATHEWS, STEPHEN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 493
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:TX
Mailing Address - Zip Code:76251-0493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6115 CAMP BOWIE BLVD STE 290
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5500
Practice Address - Country:US
Practice Address - Phone:817-831-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX756605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse