Kelly Matheson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE00010940 Issued in WA

Practice address

475 Keene Rd
Richland, WA 99352-5007

Phone

(509) 627-6888

Fax

(509) 627-6720

NPI assigned

Sep 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kelly Jones Former name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1255527016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 FAIRFAX DR",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222031762",
            "telephone_number": "703-527-3554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 KEENE RD",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993525007",
            "telephone_number": "509-627-6888",
            "fax_number": "509-627-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHESON",
        "first_name": "KELLY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-14",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00010940",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412425",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "JONES",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lynnette Martos, LMT
• Shaina Breann Marvel, DPT
• Jim Mason
• Massage by Kaylyn
• John Robert Matheson, MD
• Lauren Mathison, M.A.
• Mallory Matteo
• Skylar James Matulich, LMT
• Kelly Eileen Mauss, PHYSICAL THERAPIST
• Ellen Jean May, LMT

• Dentist in Richland, WA
• Providers in Richland, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.