Provider Demographics
NPI:1811247851
Name:MATOS, KATY ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:ELIZABETH
Last Name:MATOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:ELIZABETH
Other - Last Name:SAVASTANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:28 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2650
Mailing Address - Country:US
Mailing Address - Phone:978-465-7719
Mailing Address - Fax:
Practice Address - Street 1:28 GREEN ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2650
Practice Address - Country:US
Practice Address - Phone:978-465-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2269725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1100109518AMedicaid