Active NPI
Kevin Dale Mathis, PHARMD
- Pharmacist
- Prairie Du Chien, WI
National Provider Identifier
1891079695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 14346
- Practice address
- 109 N Marquette Rd
Prairie Du Chien, WI 53821-1512 - Phone
- (608) 326-0581
- Fax
- (608) 326-0586
- NPI assigned
- Sep 28, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 14346 | WI | Primary |
Addresses
Primary practice location
109 N Marquette Rd
Prairie Du Chien, WI 53821-1512
Mailing address
109 N Marquette Rd
Prairie Du Chien, WI 53821-1512
Phone (608) 326-0581
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14346 | WI | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317168000000",
"number": "1891079695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 N MARQUETTE RD",
"city": "PRAIRIE DU CHIEN",
"state": "WI",
"postal_code": "538211512",
"telephone_number": "608-326-0581",
"fax_number": "608-326-0586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 N MARQUETTE RD",
"city": "PRAIRIE DU CHIEN",
"state": "WI",
"postal_code": "538211512",
"telephone_number": "608-326-0581",
"fax_number": "608-326-0586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "KEVIN",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-28",
"last_updated": "2011-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "14346",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prairie Du Chien, WI
- Bobbie J Mallat, PTA
- Paul C. Mariskanish, MD
- Colleen Martin, P.T.
- Nicole D Martin, SLP
- Samantha Martin, MSW, CAPSW
- Mayo Clinic Health System-Southwest Wisconsin Region, Inc. (Mayo Clinic Health System - Franciscan Healthcare Prairie du Chien)
- Jeffrey McDonald
- Jennifer A McLellan, M.D.
- Tamara McReynolds, S.L.P
- Christopher J Mees, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.