Healthcare Provider Details

I. General information

NPI: 1205728094
Provider Name (Legal Business Name): MATTHEW TODD DANIEL APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 KY-321
PRESTONSBURG KY
41653
US

IV. Provider business mailing address

513 E DORTON BLVD
STAFFORDSVILLE KY
41256-9128
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-8511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4043423
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: