Provider Demographics
NPI:1225422140
Name:METHOT, NATHANIEL (NP)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:METHOT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18880 CHERRY VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-9506
Mailing Address - Country:US
Mailing Address - Phone:209-928-5400
Mailing Address - Fax:
Practice Address - Street 1:18880 CHERRY VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379-9506
Practice Address - Country:US
Practice Address - Phone:209-928-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002614363L00000X
CA814808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily