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General NPI Number Information
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NPI Number | 1891715454
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Entity Type | Individual
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Provider Name | ALEXANDER MACDONALD MATSON ARNP
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1310 24TH AVE S
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City | NASHVILLE
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State | TN
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Zip | 37212-2637
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Country | US
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Telephone | 615-327-4751
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Fax | 270-798-5870
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Provider Business Mailing Address
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Address Line | 10147 CERULEAN RD
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City | CERULEAN
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State | KY
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Zip | 42215-7519
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Country | US
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Telephone | 270-235-0741
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2632P
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License Number State | KY
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