Individual
KEITH MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 225-9823
Mailing address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
2012019640
MO
Other
Enumeration date
03/25/2020
Last updated
03/25/2020
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