Provider Demographics
NPI:1659085314
Name:MATHEW, STANLEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 SNOW GOOSE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-2001
Mailing Address - Country:US
Mailing Address - Phone:469-321-0616
Mailing Address - Fax:
Practice Address - Street 1:2021 N MACARTHUR BLVD STE 210
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2210
Practice Address - Country:US
Practice Address - Phone:469-800-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1102204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily