Healthcare Provider Details

I. General information

NPI: 1720994577
Provider Name (Legal Business Name): MATTHEW COTTEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOFFMAN DR STE L
HENDERSON KY
42420-3390
US

IV. Provider business mailing address

PO BOX 1679
EVANSVILLE IN
47706-0080
US

V. Phone/Fax

Practice location:
  • Phone: 270-826-5216
  • Fax: 270-826-2034
Mailing address:
  • Phone: 270-826-5216
  • Fax: 270-826-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number308123
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: