Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R850667 | MS |
NPI | 1083687586 |
---|---|
Provider Name | Keri J Jones Matheus |
First Address | Santa Rosa Beach, FL 32459-7482 |
Second Address | Santa Rosa Beach, FL 32459-7482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 01/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03752321 | (05) | MS |
P91996 | (02) |