Provider Demographics
NPI:1265143721
Name:MATTHEWS, ROHAN (PMHNP-BC, APRN, NP)
Entity type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PMHNP-BC, APRN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 EXECUTIVE CENTER DR STE 235
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8821
Mailing Address - Country:US
Mailing Address - Phone:704-936-0200
Mailing Address - Fax:
Practice Address - Street 1:5500 EXECUTIVE CENTER DR STE 235
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8821
Practice Address - Country:US
Practice Address - Phone:704-936-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QC1500X
NC5017891363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC205276OtherRN LICENSE