MEDICARE: DR. RYAN PAUL MATTESON DNP, FNP-C

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	AP139501	TX

General Provider Information

NPI Number	:	1912474479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN PAUL MATTESON DNP, FNP-C

Provider Business Mailing Address
First Line	:	2821 BUCKTHORN RD
Second Line	:
City	:	NORTHLAKE
State	:	TX
Zip	:	76226-3242
Country	:	US
Telephone Number	:	940-465-9748
Fax Number	:

Provider Business Practice Location Address
First Line	:	3247 DAWES DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-5760
Country	:	US
Telephone Number	:	214-330-7767
Fax Number	:	214-330-7780

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

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	06/19/2024

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