MS. JESSICA LYNN MATIS DNP APRN ACNP-AG NPI 1093164402

NPI Information

NPI: 1093164402
Provider Name: MS. JESSICA LYNN MATIS, DNP, APRN, ACNP-AG
Classification: Nurse Practitioner - 363LA2100X
Entity Type: Individual

Specialization: Acute Care

PECOS Registration: Yes

Address:
GOODWIN HOUSE
3440 S. JEFFERSON STREET
BAILEYS CROSSROADS, VA
ZIP 22041
Phone: (703) 820-1488
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MS. Jessica Lynn Matis, DNP, APRN, ACNP-AG is an acute care nurse practitioner in Baileys Crossroads, VA. MS. Jessica Lynn Matis, DNP, APRN, ACNP-AG NPI is 1093164402. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

GOODWIN HOUSE
3440 S. JEFFERSON STREET
BAILEYS CROSSROADS, VA
ZIP 22041-204
Phone: (703) 820-1488

The NPI 1093164402 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/7/2016 and was last updated on 8/15/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LG0600X	Nurse Practitioner	Gerontology	3010039	KENTUCKY	No
2	363LA2100X	Nurse Practitioner	Acute Care	3010039	KENTUCKY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7100415610	MEDICAID	KENTUCKY
2	0000001021475	OTHER	KENTUCKY	ANTHEM - NNIKY
3	215034	OTHER	LOUISIANA	SIHO - NNIKY
4	201391850	MEDICAID	INDIANA
5	50112260	OTHER	KENTUCKY	PASSPORT - NNIKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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