Healthcare Provider Details

I. General information

NPI: 1467730531
Provider Name (Legal Business Name): MATTHEW PAUL VINCENT APRN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2011
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N LAKE ARTHUR AVE
JENNINGS LA
70546-5738
US

IV. Provider business mailing address

114 N LAKE ARTHUR AVE
JENNINGS LA
70546-5738
US

V. Phone/Fax

Practice location:
  • Phone: 337-246-7282
  • Fax: 866-788-0477
Mailing address:
  • Phone: 337-246-7282
  • Fax: 866-788-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06587
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: