Basic Information
| Provider Information | |||||||||
| NPI: | 1821493446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTISON | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 475 COLONIAL RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381174016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015683729 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6029 WALNUT GROVE RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016853490 | ||||||||
| FaxNumber: | 9016853499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2014 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 119039 | TN | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LA2100X | APN0000028051 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.