Healthcare Provider Details

I. General information

NPI: 1417664178
Provider Name (Legal Business Name): AMBER LEE MATTHEWS MSN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD
AUSTIN TX
78723-3051
US

IV. Provider business mailing address

11600 OAK TRL
AUSTIN TX
78753-2840
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0050
  • Fax:
Mailing address:
  • Phone: 817-437-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number202213930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: