Provider Demographics
NPI:1922000736
Name:MATTHEWS, SUSAN B (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-8963
Mailing Address - Country:US
Mailing Address - Phone:270-274-9222
Mailing Address - Fax:270-274-0696
Practice Address - Street 1:1621 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8963
Practice Address - Country:US
Practice Address - Phone:270-274-9222
Practice Address - Fax:270-274-0696
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-11-28
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
KY2835P363LF0000X
KY3002835363LF0000X
KYP2271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006764Medicaid
KY000000263813OtherANTHEM BCBS
KYP22771Medicare UPIN
KY78006764Medicaid