Provider Demographics
NPI:1831672088
Name:MATHEW, PREETHY SARA (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:PREETHY
Middle Name:SARA
Last Name:MATHEW
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W PARKER RD STE 536
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8137
Mailing Address - Country:US
Mailing Address - Phone:972-378-9560
Mailing Address - Fax:844-290-4363
Practice Address - Street 1:6124 W PARKER RD STE 536
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8137
Practice Address - Country:US
Practice Address - Phone:972-378-9560
Practice Address - Fax:844-290-4363
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138397363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care