Ellisa A Mathis, FNP'C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN068928 Issued in GA

Practice address

409 Uvalda St
Waycross, GA 31501-4574

Phone

(912) 283-1359

Fax

(912) 283-1362

NPI assigned

Aug 25, 2006

Last updated

Oct 30, 2009By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256860800000",
    "number": "1801903596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BEACON ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315017104",
            "telephone_number": "912-287-4434",
            "fax_number": "912-287-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 UVALDA ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014574",
            "telephone_number": "912-283-1359",
            "fax_number": "912-283-1362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "ELLISA",
        "middle_name": "A",
        "name_prefix": "Miss",
        "credential": "FNP'C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2009-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN068928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andy M Martin, CRNA
• Earl T Martin, M.D.
• Kaitlyn Suzanne Martin, PTA
• Kristen Brooke Martin, APRN, FNP-C
• Virginia Martin, O.D.
• Kalie Deann Mathis, NP-C
• Scott Mathis, APRN,BC
• Diana Maurer, O.D.
• Mayo Clinic Health System in Waycross
• Mayo Clinic Health System in Waycross, Inc

• Family Nurse Practitioner in Waycross, GA
• Providers in Waycross, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2009; 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.