Mathis, Audrey A

Mathis, Audrey A is an individual health care provider with primary practice located at 4103 Medical Center Dr , Fayetteville NY 13066-6600. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Mathis, Audrey A can be contacted via phone (315) 637-7800.

Contact Information

Primary practice address
4103 Medical Center Dr Fayetteville NY 13066-6600
Phone: (315) 637-7800
Fax: (315) 637-7808
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 320426 New York
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X F332143 New York

Profile Details

NPI number 1740283829
LBN Legal business name Mathis, Audrey A
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2005
Last updated Nov 22nd, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740283829 NPPES
New York MEDICAID 02119060

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