MEDICARE: TONYA CHARLENE MATSON ARNP

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	363L00000X	Nurse Practitioner	R0044651	OK

General Provider Information

NPI Number	:	1861593162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA CHARLENE MATSON ARNP

Provider Business Mailing Address
First Line	:	6922 S WESTERN AVE
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1803
Country	:	US
Telephone Number	:	405-631-0483
Fax Number	:	405-632-4588

Provider Business Practice Location Address
First Line	:	6922 S WESTERN AVE
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1803
Country	:	US
Telephone Number	:	405-631-0483
Fax Number	:	405-632-4588

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/03/2015

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