Provider Demographics
NPI:1982909453
Name:MATTHEWS, SANDRA (NP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39533-0555
Mailing Address - Country:US
Mailing Address - Phone:228-563-6800
Mailing Address - Fax:228-563-6803
Practice Address - Street 1:9350 HIGHWAY 49
Practice Address - Street 2:SUITE A
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4213
Practice Address - Country:US
Practice Address - Phone:228-563-6800
Practice Address - Fax:228-563-6803
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily