Provider Demographics
NPI:1992200950
Name:MATHEWS, CRISTY M (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:M
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 U S HIGHWAY 49
Mailing Address - Street 2:SUITE 30
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7567
Mailing Address - Country:US
Mailing Address - Phone:601-884-0632
Mailing Address - Fax:
Practice Address - Street 1:5914 U S HIGHWAY 49 STE 30
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7567
Practice Address - Country:US
Practice Address - Phone:160-188-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty