Provider Demographics
NPI:1194796177
Name:MATHERS, RACHEL A (RNC, FNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:MATHERS
Suffix:
Gender:F
Credentials:RNC, FNP
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 577
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37822-0577
Mailing Address - Country:US
Mailing Address - Phone:423-613-3320
Mailing Address - Fax:423-623-4088
Practice Address - Street 1:229 HEDRICK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2902
Practice Address - Country:US
Practice Address - Phone:423-623-1057
Practice Address - Fax:423-625-8620
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN140110163W00000X
TNAPN8426363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100043256OtherPHP TENNCARE
TN3349050Medicaid
TN4066862OtherBCBST
TN4066866OtherBCBST
TN4066860OtherBCBST
TN4066861OtherBLUECARE-PARROTTSVILLE
TN4066865OtherBCBST
P90679Medicare UPIN