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NPI Code Detail

MEDICARE: MARY L MATTHEWS ANP

MEDICARE:   MARY L MATTHEWS  ANP
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
1363LF0000XFamily Nurse PractitionerAO1188 ANPAR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194916973
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY L MATTHEWS ANP
Provider Business Mailing Address
First Line : 1900 MALVERN AVE STE 401
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71901-7779
Country : US
Telephone Number : 501-623-6455
Fax Number :
Provider Business Practice Location Address
First Line : 1900 MALVERN AVE STE 401
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71901-7779
Country : US
Telephone Number : 501-623-6455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2007
Last Update Date : 07/19/2011

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