Provider Demographics
NPI:1871238378
Name:MATTESON, AUDREY GRACE (CNP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:GRACE
Last Name:MATTESON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:GRACE
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 JASONWAY AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4361
Mailing Address - Country:US
Mailing Address - Phone:614-459-2950
Mailing Address - Fax:614-459-2975
Practice Address - Street 1:770 JASONWAY AVE STE 1A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4361
Practice Address - Country:US
Practice Address - Phone:614-459-2950
Practice Address - Fax:614-459-2975
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031374363L00000X
OH451314163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner