MEDICARE: MATTHEW LEE CARY FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71009515A	IN
2	363L00000X	Nurse Practitioner	209.011435	IL
3	363L00000X	Nurse Practitioner	2007022814	MO
4	363LF0000X	Family Nurse Practitioner	2012005560	MO

General Provider Information

NPI Number	:	1619233525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW LEE CARY FNP-BC

Provider Business Mailing Address
First Line	:	3960 LINDELL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3204
Country	:	US
Telephone Number	:	314-652-0100
Fax Number	:	314-531-1768

Provider Business Practice Location Address
First Line	:	3960 LINDELL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3204
Country	:	US
Telephone Number	:	314-652-0100
Fax Number	:	314-531-1768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	02/18/2022

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