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General NPI Number Information
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NPI Number | 1639692965
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Entity Type | Individual
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Provider Name | MATTHEW STEVEN RICH MSN, RN, AGCNS-BC
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Gender | Male
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 2323 W FRONT ST
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City | TYLER
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State | TX
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Zip | 75702-7747
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Country | US
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Telephone | 903-597-1351
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Fax | 903-597-1351
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Provider Business Mailing Address
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Address Line | 4010 CLOVERDALE DR
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City | TYLER
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State | TX
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Zip | 75701-9314
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Country | US
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Telephone | 480-242-7129
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | AP134553
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 880140
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License Number State | TX
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