Healthcare Provider Details

I. General information

NPI: 1700354578
Provider Name (Legal Business Name): MATTHEW CHRISTIAN STALLARD MS, APRN, AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 N HIGH ST
COLUMBUS OH
43214-1694
US

IV. Provider business mailing address

5155 N HIGH ST
COLUMBUS OH
43214-1694
US

V. Phone/Fax

Practice location:
  • Phone: 614-842-8007
  • Fax:
Mailing address:
  • Phone: 614-842-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.022881
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number300563
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.022881
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.022881
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.022881
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: