Healthcare Provider Details

I. General information

NPI: 1144996299
Provider Name (Legal Business Name): AMY NICOLE MATZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W GRAND ST STE B
SPRINGFIELD MO
65802-4802
US

IV. Provider business mailing address

440 E TAMPA ST
SPRINGFIELD MO
65806-1131
US

V. Phone/Fax

Practice location:
  • Phone: 417-872-7761
  • Fax: 417-447-0573
Mailing address:
  • Phone: 417-831-0150
  • Fax: 417-447-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021033184
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: