Provider Demographics
NPI:1508950635
Name:MATTHEWS, THERESA J (CRNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2421
Mailing Address - Country:US
Mailing Address - Phone:256-259-5313
Mailing Address - Fax:256-259-4923
Practice Address - Street 1:21680 AL HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-5904
Practice Address - Country:US
Practice Address - Phone:256-587-3050
Practice Address - Fax:256-587-3508
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-049084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL136138Medicaid
AL51122652OtherBLUE CROSS BLUE SHIELD
AL51122664OtherBLUE CROSS BLUE SHIELD
AL136246Medicaid
AL51122650OtherBLUE CROSS BLUE SHIELD
AL51122654OtherBLUE CROSS BLUE SHIELD
AL51122655OtherBLUE CROSS BLUE SHIELD
AL630760576008OtherTRICARE
AL136244Medicaid
AL5112653OtherBLUE CROSS BLUE SHIELD
AL51122655OtherBLUE CROSS BLUE SHIELD
AL51122650OtherBLUE CROSS BLUE SHIELD
AL136244Medicaid