Active NPI
Charlotte Katherine Mathis, PA-C, M.P.A.S.
- Physician Assistant
- Tacoma, WA
National Provider Identifier
1386824035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA60261126
- Practice address
- 1708 Yakima Ave Ste 201
Tacoma, WA 98405-5300 - Phone
- (253) 426-4692
- Fax
- (253) 426-6939
- NPI assigned
- Nov 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | C0003662 | MD | |
| Physician Assistant | 363A00000X | 0110002615 | VA | |
| Physician Assistant | 363A00000X | PA030515 | DC | |
| Physician Assistant | 363A00000X | PA60261126 | WA | Primary |
| Physician Assistant | 363A00000X | 52423 | CA |
Addresses
Primary practice location
1708 Yakima Ave Ste 201
Tacoma, WA 98405-5300
Mailing address
1708 Yakima Ave Ste 201
Tacoma, WA 98405-5300
Phone (253) 426-4692
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003207C95 | Other | MEDICARE IDENTIFICATION NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52423 | CA | MD | Pharmacist |
| C0003662 | MD | MD | Physician Assistant |
| 0110002615 | VA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466467200000",
"number": "1386824035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1708 YAKIMA AVE STE 201",
"city": "TACOMA",
"state": "WA",
"postal_code": "984055300",
"telephone_number": "253-426-4692",
"fax_number": "253-426-6939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1708 YAKIMA AVE STE 201",
"city": "TACOMA",
"state": "WA",
"postal_code": "984055300",
"telephone_number": "253-426-4692",
"fax_number": "253-426-6939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "CHARLOTTE",
"middle_name": "KATHERINE",
"name_prefix": "Ms.",
"credential": "PA-C, M.P.A.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-10",
"last_updated": "2016-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "C0003662",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110002615",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "DC",
"license": "PA030515",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA60261126",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "52423",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE IDENTIFICATION NUMBER",
"identifier": "003207C95",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.