Provider Demographics
NPI:1356182612
Name:MATTHEWS, QANTASIA S
Entity type:Individual
Prefix:
First Name:QANTASIA
Middle Name:S
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 1:3740 HOLTON CIR APT 3301
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-8409
Mailing Address - Country:US
Mailing Address - Phone:512-400-5954
Mailing Address - Fax:
Practice Address - Street 1:104 DIXON AVE
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785
Practice Address - Country:US
Practice Address - Phone:512-400-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No374U00000XNursing Service Related ProvidersHome Health Aide