Provider Demographics
NPI:1952809949
Name:MATTOS, KARI ANN (NP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:ANN
Last Name:MATTOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:ANN
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:37 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3930
Mailing Address - Country:US
Mailing Address - Phone:802-891-9395
Mailing Address - Fax:
Practice Address - Street 1:89 PLAZA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6438
Practice Address - Country:US
Practice Address - Phone:518-314-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0095344163W00000X
VT101-0134258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse