Provider Demographics
NPI:1124491618
Name:MATHEW, KANMONY (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:KANMONY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:KANMONY
Other - Middle Name:
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNPC-AG
Mailing Address - Street 1:17210 BLAND MILLS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2718
Mailing Address - Country:US
Mailing Address - Phone:832-454-7694
Mailing Address - Fax:
Practice Address - Street 1:17210 BLAND MILLS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2718
Practice Address - Country:US
Practice Address - Phone:832-454-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129286363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care