Provider Demographics
NPI:1538934179
Name:MATOS, CALEN BRIANA (BSN, RN, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:CALEN
Middle Name:BRIANA
Last Name:MATOS
Suffix:
Gender:F
Credentials:BSN, RN, CPNP-PC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:880 CHESHAM AVE
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5984
Mailing Address - Country:US
Mailing Address - Phone:706-284-9442
Mailing Address - Fax:
Practice Address - Street 1:1000 CLYBURN PL
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4193
Practice Address - Country:US
Practice Address - Phone:803-380-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN278836363LP0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics