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General NPI Number Information
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NPI Number | 1174052690
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Entity Type | Individual
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Provider Name | MATTHEW ROBERT COMBS
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Gender | Male
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 4000 LINWOOD DR STE I
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City | PARAGOULD
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State | AR
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Zip | 72450-7224
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Country | US
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Telephone | 870-239-8102
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 SUMMERHILL DR
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City | PARAGOULD
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State | AR
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Zip | 72450-5563
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A005172
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License Number State | AR
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