Waverly Primary Care, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

WAVERLY PRIMARY CARE, PLLC

Practice address

9329 State Hwy 75
New Waverly, TX 77358

Phone

(936) 284-2055

NPI assigned

Apr 24, 2020

Last updated

Apr 24, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kristina Mata, FNP-CNPI 1508236241

Title

Owner, Authorized Official

Phone

(936) 284-2055

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristina Mata, FNP-C

  • Family Nurse Practitioner
  • New Waverly, TX
  • NPI 1508236241
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587686400000",
    "number": "1215557715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 LONG HORN LOOP",
            "city": "NEW WAVERLY",
            "state": "TX",
            "postal_code": "773583735",
            "telephone_number": "936-284-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9329 STATE HWY 75",
            "city": "NEW WAVERLY",
            "state": "TX",
            "postal_code": "77358",
            "telephone_number": "936-284-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLY PRIMARY CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-24",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A",
        "authorized_official_last_name": "MATA",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "OWNER, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "936-284-2055",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in New Waverly, TX
• Providers in New Waverly, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.