Healthcare Provider Details

I. General information

NPI: 1306195102
Provider Name (Legal Business Name): MATTHEW J MAY NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL PL STE 103
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

291 N FIREWEED ST
SOLDOTNA AK
99669-7540
US

V. Phone/Fax

Practice location:
  • Phone: 907-260-5455
  • Fax: 907-714-3111
Mailing address:
  • Phone: 907-262-6454
  • Fax: 907-262-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number167884
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number33069
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: