Healthcare Provider Details

I. General information

NPI: 1326785692
Provider Name (Legal Business Name): MATTHEW KYLE VEDDER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404-1161
US

IV. Provider business mailing address

486 BEATEN PATH RD E
SIGNAL MOUNTAIN TN
37377-2912
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-2525
  • Fax:
Mailing address:
  • Phone: 605-430-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number224156
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: