WAVERLY PRIMARY CARE, PLLC (NPI# 1215557715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215557715 |
| Entity Type | Organization |
| Organization Name | WAVERLY PRIMARY CARE, PLLC |
| Practice Address |
9329 State Hwy 75 New Waverly TX 77358 |
| Mailing Address |
24 Long Horn Loop New Waverly TX 77358-3735 |
| Practice Telephone | 9362842055 |
| Mailing Telephone | 9362842055 |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2020-04-24 |
| Authorized Official Name | KRISTINA MATA (OWNER, AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 9362842055 |
| Authorized Official Credential | FNP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
9329 STATE HWY 75 |
| City | NEW WAVERLY |
| State | TX |
| Zip Code | 77358 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699201863 | Kathryn Claire Ryan | Specialist/Technologist | 266 Sh 150, New Waverly, TX 77358 | 2017-05-10 |
| 1508236241 | Kristina Mata | Nurse Practitioner | 9329 State Hwy 75 S., New Waverly, TX 77358 | 2015-10-06 |
| 1063548238 | New Waverly Isd | Local Education Agency (LEA) | 355 Front St, New Waverly, TX 77358-3527 | 2007-02-24 |
| 1063913390 | Taryn Leigh Moore | Specialist/Technologist | 355 Front St, New Waverly, TX 77358-3527 | 2018-02-22 |
| 1124327622 | Compliance Toxicology LLC | Clinical Medical Laboratory | 370 Gibbs St, New Waverly, TX 77358-3642 | 2011-03-23 |
| 1275937997 | Core Medical Solutions, LLC | Home Health | 14a Goffney Rd, New Waverly, TX 77358-3828 | 2014-10-09 |
| 1316245897 | Knewman Holdings, LLC | Assisted Living Facility | 929 State Highway 150, New Waverly, TX 77358-3879 | 2011-03-07 |
| 1851432686 | The Raven School Gulf Coast Trade Center | Local Education Agency (LEA) | 143 Forest Service Road 233, New Waverly, TX 77358-3945 | 2007-02-12 |
| 1295909042 | Phillip Wayne Wells | Physical Therapist | 32 Dana Dr, New Waverly, TX 77358-4001 | 2008-04-14 |
| 1235210329 | Jesse Schneringer | Chiropractor | 403 Hostetter Road, New Waverly, TX 77358-4070 | 2006-10-17 |
| Find all providers in zip 77358 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508236241 | Kristina Mata | Nurse Practitioner | 9329 State Hwy 75 S., New Waverly, TX 77358 | 2015-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255162 | Shaida Rahmatinick | Nurse Practitioner | 1515 W 22nd St, Houston, TX 77008-1501 | 2020-11-08 |
| 1891396586 | Stacey Lynne Ready | Nurse Practitioner | 200 Uptmore Rd, West, TX 76691-2339 | 2020-11-08 |
| 1992306609 | Jillian Mcclintock | Nurse Practitioner | 2506 Graystone Ln, Corinth, TX 76210-1607 | 2020-11-08 |
| 1851992515 | Stacie A Gregg | Nurse Practitioner | 1229 Johnny Ln, San Angelo, TX 76905-2331 | 2020-11-07 |
| 1285235929 | Activate Family Health, Pllc | Nurse Practitioner | 203 E Davis St Ste F-1026, Conroe, TX 77301-3159 | 2020-11-07 |
| 1629679782 | Kristen Aili Johnson | Nurse Practitioner | 3850 Fm 18, Abilene, TX 79602-2004 | 2020-11-05 |
| 1376144303 | Stephanie Renee Knight | Nurse Practitioner | 4326 Egret Dr, Seabrook, TX 77586-2557 | 2020-11-05 |
| 1457952319 | Olufunke Oyindamola Oshoba | Nurse Practitioner | 200 Odyssey Ln, Mansfield, TX 76063-3438 | 2020-11-05 |
| 1518568419 | Ian Mardis | Nurse Practitioner | 12528 Tierra Encino Dr, El Paso, TX 79938-4525 | 2020-11-05 |
| 1851992994 | Angela Davis | Nurse Practitioner | 9523 Scanlan Heights Ln, Missouri City, TX 77459-5503 | 2020-11-05 |
| Find all providers with the same taxonomy | ||||
| City | NEW WAVERLY |
| Zip Code | 77358 |
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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.