MEDICARE: DYMON MATTHEWS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F11250256	TX

General Provider Information

NPI Number	:	1104784891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYMON MATTHEWS FNP

Provider Business Mailing Address
First Line	:	8326 DIVOT TRCE
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-2175
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8326 DIVOT TRCE
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-2175
Country	:	US
Telephone Number	:	832-474-1442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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