Provider Demographics
NPI:1619949427
Name:MATTHEWS, CAROL A (NP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E REPUBLIC RD STE D200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6012
Mailing Address - Country:US
Mailing Address - Phone:417-883-7889
Mailing Address - Fax:417-890-6151
Practice Address - Street 1:909 E REPUBLIC RD STE D200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6012
Practice Address - Country:US
Practice Address - Phone:417-883-7889
Practice Address - Fax:417-890-6151
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO058827163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427725924Medicaid