Provider Demographics
NPI:1760147144
Name:MATTHEWS, KRISTINA RENE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RENE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 GENE GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6385
Mailing Address - Country:US
Mailing Address - Phone:479-750-0130
Mailing Address - Fax:479-750-0937
Practice Address - Street 1:2575 GENE GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6385
Practice Address - Country:US
Practice Address - Phone:479-750-0130
Practice Address - Fax:479-750-0937
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0107596163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse