Provider Demographics
NPI:1639407331
Name:MATTHEWS, EMILY KATE (DO)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:KATE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-1652
Mailing Address - Country:US
Mailing Address - Phone:601-512-0431
Mailing Address - Fax:601-482-5065
Practice Address - Street 1:4612 29TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-1652
Practice Address - Country:US
Practice Address - Phone:601-512-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23115207R00000X, 207N00000X
FLU01893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine