Provider Demographics
NPI:1265583207
Name:MATTHEWS, KIM (FNP)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RACHEL LANE
Mailing Address - Street 2:POB 107
Mailing Address - City:BREVIG MISSION
Mailing Address - State:AK
Mailing Address - Zip Code:99785
Mailing Address - Country:US
Mailing Address - Phone:907-642-2307
Mailing Address - Fax:
Practice Address - Street 1:21 RACHEL LANE
Practice Address - Street 2:
Practice Address - City:BREVIG MISSION
Practice Address - State:AK
Practice Address - Zip Code:99785
Practice Address - Country:US
Practice Address - Phone:907-642-2307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110176163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice