Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kenneth E Mathis, RPA

Individual provider Physician Assistant · NPI 1518053719

Kenneth E Mathis, RPA is a Physician Assistant in Waterloo, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2006

Practice location Address checks out

367 E Main St
Waterloo, NY 13165-1643
Phone: (315) 787-4977
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 003372 (NY)

Record details

NPI number1518053719
Entity typeIndividual (Type 1)
GenderMale
Credentials RPA
Sole proprietorYes
NPI enumeratedOctober 5, 2006
Last updated in NPPESOctober 5, 2007
Mailing address196 North St, Geneva, NY 14456-1651