MEDICARE: MR. MATTHEW PAUL VINCENT APRN-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	363LF0000X	Family Nurse Practitioner	AP06587	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1467730531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW PAUL VINCENT APRN-BC

Provider Business Mailing Address
First Line	:	114 N LAKE ARTHUR AVE
Second Line	:
City	:	JENNINGS
State	:	LA
Zip	:	70546-5738
Country	:	US
Telephone Number	:	337-246-7282
Fax Number	:	866-788-0477

Provider Business Practice Location Address
First Line	:	114 N LAKE ARTHUR AVE
Second Line	:
City	:	JENNINGS
State	:	LA
Zip	:	70546-5738
Country	:	US
Telephone Number	:	337-246-7282
Fax Number	:	866-788-0477

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

Provider Enumeration Date	:	07/23/2011
Last Update Date	:	04/09/2015

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