Kristen Malibu Mathis, R.N.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

246277 Issued in NC

Practice address

4513 Edwards Mill Rd
Suite H
Raleigh, NC 27612-3779

Phone

(252) 646-6847

NPI assigned

Apr 2, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427932800000",
    "number": "1417342882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4513 EDWARDS MILL RD",
            "address_2": "SUITE H",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123779",
            "telephone_number": "252-646-6847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4513 EDWARDS MILL RD",
            "address_2": "SUITE H",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123779",
            "telephone_number": "252-646-6847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "KRISTEN",
        "middle_name": "MALIBU",
        "name_prefix": "Ms.",
        "credential": "R.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-02",
        "last_updated": "2015-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "246277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC NURSING LICENSE",
            "identifier": "246277",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anil Mathen Mathew, D.M.D.
• Annie Philip Mathew, D.M.D.
• Vinod Verghese Mathew, D.D.S.
• Carolyn E Mathiot, PTA
• Jason Mathis, COTA/L
• Marisha Larae Mathis, LCSW
• Patricia Ann Mathis
• Teimeka Mathis
• James Michael Mathues, MOT, OTR/L
• Tushar Mathur, MD

• Registered Nurse in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Registered Nurse in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; 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.