Active NPI
Kelly J Matthews, B.S.
- Specialist
- Avondale, AZ
National Provider Identifier
1528256583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 0788
- Practice address
- 13055 W McDowell Rd. Suite G-107
Avondale, AZ 85323 - Phone
- (623) 640-9819
- NPI assigned
- Oct 4, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 0788 | AZ | Primary |
Addresses
Primary practice location
13055 W McDowell Rd. Suite G-107
Avondale, AZ 85323
Mailing address
16908 W Weymouth Rd
Surprise, AZ 85374-0840
Phone (623) 640-9819
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)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0788 | AZ | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191456000000",
"number": "1528256583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16908 W WEYMOUTH RD",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853740840",
"telephone_number": "623-640-9819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13055 W MCDOWELL RD. SUITE G-107",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "85323",
"telephone_number": "623-640-9819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHEWS",
"first_name": "KELLY",
"middle_name": "J",
"credential": "B.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-04",
"last_updated": "2007-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AZ",
"license": "0788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avondale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.