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General NPI Number Information
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NPI Number | 1235747536
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Entity Type | Individual
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Provider Name | MATTHEW LOVEJOY FNP-C
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Gender | Male
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 108 6TH AVE
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City | KINDER
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State | LA
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Zip | 70648-3187
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Country | US
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Telephone | 337-738-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 206 MADISON ST
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City | SULPHUR
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State | LA
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Zip | 70663-6324
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Country | US
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Telephone | 931-253-1110
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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 | 214619
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License Number State | LA
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