Provider Demographics
NPI:1972906931
Name:MATTHEWS, MISTI L (PCA)
Entity type:Individual
Prefix:MS
First Name:MISTI
Middle Name:L
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 LEONA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3035
Mailing Address - Country:US
Mailing Address - Phone:614-515-8687
Mailing Address - Fax:
Practice Address - Street 1:1029 LEONA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3035
Practice Address - Country:US
Practice Address - Phone:614-515-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01069953747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant