Healthcare Provider Details

I. General information

NPI: 1922000736
Provider Name (Legal Business Name): SUSAN B MATTHEWS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 11/28/2019
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

1621 N MAIN ST
BEAVER DAM KY
42320-8963
US

IV. Provider business mailing address

1621 N MAIN ST
BEAVER DAM KY
42320-8963
US

V. Phone/Fax

Practice location:
  • Phone: 270-274-9222
  • Fax: 270-274-0696
Mailing address:
  • Phone: 270-274-9222
  • Fax: 270-274-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2835P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3002835
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberP2271
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: