Provider Demographics
NPI:1487455440
Name:MATHIS, TIESHA KEONI (APRN)
Entity type:Individual
Prefix:MRS
First Name:TIESHA
Middle Name:KEONI
Last Name:MATHIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TIESHA
Other - Middle Name:KEONI
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SC HOUSE CALLS INC.
Mailing Address - Street 2:111 DOCTOR CIR
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6502
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:
Practice Address - Street 1:SC HOUSE CALLS INC.
Practice Address - Street 2:111 DOCTOR CIR
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6502
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse