MATHIS DREAM LLC (NPI# 1164649703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164649703 |
| Entity Type | Organization |
| Organization Name | MATHIS DREAM LLC |
| Other Organization Name | BAKER FAMILY MEDICAL CLINIC |
| Practice Address |
1321 Georgia Ave Baker FL 32531-2605 |
| Practice Telephone | 8505372700 |
| Practice Fax Number | 8505372702 |
| Mailing Telephone | 8505372700 |
| Mailing Fax Number | 8505372702 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. DEBRA LYNN MATHIS (OWNER- NURSE PRACTITIONER) |
| Authorized Official Telephone | 8505372700 |
| Authorized Official Credential | ARNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
ARNP 1427202 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | OCCUPATIONAL LICENSE | 3600100732600 | 01 |
| Other Name | Type Code |
|---|---|
| Baker Family Medical Clinic | Doing Business As Name - Organization |
| Street Address |
1321 GEORGIA AVE |
| City | BAKER |
| State | FL |
| Zip Code | 32531-2605 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750582276 | Baker Family Medical Clinic | Family Medicine | 1321 Georgia Ave, Baker, FL 32531-2605 | 2007-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669569257 | Michelle H Stevens Md Pa | Family Medicine | 1200 Henley Lane, Baker, FL 32531 | 2006-10-06 |
| 1386661254 | Health-smart Pharmacy Inc. | Durable Medical Equipment & Medical Supplies | 5809 Highway 189 N, Baker, FL 32531-2501 | 2006-07-16 |
| 1710028865 | Melody Thompson Bolton | Pharmacist | 5809 Highway 189 N, Baker, FL 32531-2501 | 2007-02-10 |
| 1023205051 | Michelle H Vandenbosch | Family Medicine | 5808b Highway 189 N, Baker, FL 32531-2506 | 2007-10-03 |
| 1164649794 | Debra Lynn Mathis | Nurse Practitioner | 1321 Georgia Avenue, Baker, FL 32531-2605 | 2007-04-18 |
| 1235141425 | Marianne W. C. Tullus | Family Medicine | 1200 Henley Ln, Baker, FL 32531-2702 | 2006-08-13 |
| 1396201190 | Liza Ann Eiriksson | Nurse Practitioner | 1200 Henley Ln, Baker, FL 32531-2702 | 2019-02-16 |
| 1356520555 | Allison Nicole Hohider | Licensed Practical Nurse | 1369 14th St, Baker, FL 32531-2809 | 2007-10-24 |
| 1356886295 | Lindsay N Gatewood | Specialist/Technologist | 817 Melton Rd, Baker, FL 32531-5373 | 2017-01-02 |
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902202278 | Mps Quickcare, LLC | Nurse Practitioner | 14224 Felicity Dr, Baker, LA 70714-5420 | 2014-11-13 |
| 1376972406 | Oreal Perkins | Nurse Practitioner | 17511 Wisdom Dr, Baker, LA 70714-1527 | 2013-11-08 |
| 1518211853 | Baker School Based Health Clinic | Nurse Practitioner | 3033 Ray Weiland Dr # B, Baker, LA 70714-3251 | 2012-11-08 |
| 1225388929 | Kendra Paul Patrick | Nurse Practitioner | 14224 Felicity Drive, Baker, LA 70714 | 2012-09-11 |
| 1164649794 | Debra Lynn Mathis | Nurse Practitioner | 1321 Georgia Avenue, Baker, FL 32531-2605 | 2007-04-18 |
| 1508414855 | Hailey Mcmanus Murphy | Nurse Practitioner | 12902 Plank Rd, Baker, LA 70714-4911 | 2019-08-29 |
| 1760905343 | Elizabeth Ann Mouton | Nurse Practitioner | 12880 Plank Rd, Baker, LA 70714-4909 | 2017-07-25 |
| 1326453689 | Rebecca A Davis Fnp-c LLC | Nurse Practitioner | 12902 Plank Rd, Baker, LA 70714-4911 | 2014-06-25 |
| 1922353424 | Freddy D Conley | Nurse Practitioner | 17978 Sr 55, Baker, WV 26801 | 2012-07-20 |
| 1912262429 | Stephanie Linton Nolan | Nurse Practitioner | 12880 Plank Rd, Baker, LA 70714-4909 | 2012-07-10 |
| Find all providers in BAKER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.