Healthcare Provider Details

I. General information

NPI: 1386778686
Provider Name (Legal Business Name): LILLIAN MATTHEWS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 DEBORAH DRIVE
MONROE LA
71201
US

IV. Provider business mailing address

3308 DEBORAH DRIVE
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-7431
  • Fax:
Mailing address:
  • Phone: 318-325-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN058863
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP03695
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: