Healthcare Provider Details

I. General information

NPI: 1265981856
Provider Name (Legal Business Name): MATTHEW AKERS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W LIBERTY ST
FARMINGTON MO
63640-1921
US

IV. Provider business mailing address

1101 W LIBERTY ST
FARMINGTON MO
63640-1921
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-6451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2106034346
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2106034346
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: