Healthcare Provider Details

I. General information

NPI: 1154974889
Provider Name (Legal Business Name): MATTHEW J AYALA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MEDI PARK DR STE 2
AMARILLO TX
79106-2105
US

IV. Provider business mailing address

101 W LOUIS HENNA BLVD STE 300
AUSTIN TX
78728-1203
US

V. Phone/Fax

Practice location:
  • Phone: 806-350-7918
  • Fax: 806-418-8982
Mailing address:
  • Phone: 512-244-4272
  • Fax: 512-244-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142392
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: