MEDICARE: MATTHEW HILLIS APRN

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	R0117364	OK

General Provider Information

NPI Number	:	1871184911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW HILLIS APRN

Provider Business Mailing Address
First Line	:	3077 E COLLEGE AVE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-8065
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3077 E COLLEGE AVE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-8065
Country	:	US
Telephone Number	:	405-282-3898
Fax Number	:

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

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	02/01/2021

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