MEDICARE: REYNA MARLENE MATEO AGPCNP-BC

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	363LP2300X	Primary Care Nurse Practitioner	29507	TN

General Provider Information

NPI Number	:	1316739758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNA MARLENE MATEO AGPCNP-BC

Provider Business Mailing Address
First Line	:	1270 COOK RD
Second Line	:
City	:	IRON CITY
State	:	TN
Zip	:	38463-4625
Country	:	US
Telephone Number	:	931-724-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1270 COOK RD
Second Line	:
City	:	IRON CITY
State	:	TN
Zip	:	38463-4625
Country	:	US
Telephone Number	:	931-724-4590
Fax Number	:

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

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	05/21/2025

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