Basic Information
| Provider Information | |||||||||
| NPI: | 1497209894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHENY | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8109 FREDERICKSBURG RD | ||||||||
| Address2: | PHYSICIAN PRACTICE SERVICES | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105752222 | ||||||||
| FaxNumber: | 2105756373 | ||||||||
| Practice Location | |||||||||
| Address1: | 4410 MEDICAL DR | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782296306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105752222 | ||||||||
| FaxNumber: | 2105756373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2016 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 695640 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SX0204X | AP131873 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Oncology, Pediatrics | 363L00000X | 695640 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 363489101 | 05 | TX | MEDICAID | 534070YLLW | 01 | TX | MEDICARE PTAN | OTHER |