Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1-122399 | AL |
NPI | 1063814952 |
---|---|
Provider Name | Keith Matthews |
First Address | Auburn, AL 36830-6471 |
Second Address | Auburn, AL 36830-6471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2014 |
Last Update Date | 23/09/2014 |