Healthcare Provider Details

I. General information

NPI: 1528808227
Provider Name (Legal Business Name): MATTHEW JOHN JOHNTONY CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S MAIN ST
HARRISVILLE PA
16038-1623
US

IV. Provider business mailing address

PO BOX 170
BAKERSTOWN PA
15007-0170
US

V. Phone/Fax

Practice location:
  • Phone: 724-735-4224
  • Fax: 724-735-0103
Mailing address:
  • Phone: 724-674-7854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP029783
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: