Kettia Mathurin, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN195570 Issued in GA

Practice address

5667 Peachtree Dunwoody Rd Ste 260
Atlanta, GA 30342-1714

Phone

(404) 255-1030

Fax

(678) 843-6619

NPI assigned

Jun 30, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1498780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1366963175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5667 PEACHTREE DUNWOODY RD STE 260",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5667 PEACHTREE DUNWOODY RD STE 260",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421714",
            "telephone_number": "404-255-1030",
            "fax_number": "678-843-6619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHURIN",
        "first_name": "KETTIA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-30",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN195570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003202496A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kettia.mathurin.1@14360.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "5667 Peachtree Dunwoody Rd Ste 260",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303421714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sharon Ann Mathis, PH.D.
• Tomias Mathis, LPC
• Kunal Mohan Mathur, MD
• Shagun Mathur, MD
• Emilie Lauren Mathura, DO
• Carla Matias, LPC
• Abul Faiz Mohammad Matin, M.D., PH.D.
• Kate Matise
• Ricky Carter Matkins, MD
• Sahar Matloub, PHARMD

• Nurse Practitioner in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.