Healthcare Provider Details

I. General information

NPI: 1982415766
Provider Name (Legal Business Name): MATTHEW WADE ALLRED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 OLD STERLINGTON RD
MONROE LA
71203-2396
US

IV. Provider business mailing address

4400 OLD STERLINGTON RD
MONROE LA
71203-2396
US

V. Phone/Fax

Practice location:
  • Phone: 318-324-1414
  • Fax:
Mailing address:
  • Phone: 318-324-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241587
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: