Healthcare Provider Details

I. General information

NPI: 1841140837
Provider Name (Legal Business Name): SETH MATLOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

1213 VERNA LN
NIXA MO
65714-8208
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF01261072
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: