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NPI Code Detail

MEDICARE: PAMELA A. MATLOCK CRNA

MEDICARE: PAMELA A. MATLOCK CRNA
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
1367500000XCertified Registered Nurse Anesthetist526650TX

General Provider Information

NPI Number : 1407828346
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA A. MATLOCK CRNA
Provider Business Mailing Address
First Line : 5605 N MACARTHUR BLVD
Second Line : STE. 220
City : IRVING
State : TX
Zip : 75038-2617
Country : US
Telephone Number : 972-714-0007
Fax Number : 972-714-0009
Provider Business Practice Location Address
First Line : 5605 N MACARTHUR BLVD
Second Line : STE. 220
City : IRVING
State : TX
Zip : 75038-2617
Country : US
Telephone Number : 972-714-0007
Fax Number : 972-714-0009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2006
Last Update Date : 07/09/2013

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Directions to “ PAMELA A. MATLOCK CRNA” Practice Location

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