Provider Demographics
NPI:1871351205
Name:MATTHEWS, AYANA JALISA
Entity type:Individual
Prefix:
First Name:AYANA
Middle Name:JALISA
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3358 GRAND CAILLOU RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7142
Mailing Address - Country:US
Mailing Address - Phone:337-443-3666
Mailing Address - Fax:
Practice Address - Street 1:3358 GRAND CAILLOU RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-7142
Practice Address - Country:US
Practice Address - Phone:337-443-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide