Healthcare Provider Details

I. General information

NPI: 1134060627
Provider Name (Legal Business Name): MATTHEW PARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8426
US

IV. Provider business mailing address

2065 N HIGHWAY 25
JELLICO TN
37762-4614
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-1212
  • Fax:
Mailing address:
  • Phone: 606-304-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4063008
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1168455
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: