Healthcare Provider Details

I. General information

NPI: 1710408182
Provider Name (Legal Business Name): MATHEW JOHN ALBARADO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 ODD FELLOWS RD
CROWLEY LA
70526
US

IV. Provider business mailing address

345 ODD FELLOWS RD
CROWLEY LA
70526-2206
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-7004
  • Fax: 337-783-0070
Mailing address:
  • Phone: 337-783-7004
  • Fax: 337-783-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09338
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: