Provider Demographics
NPI:1174138473
Name:MATTHEWS, NICKOLAS (APRN-CNP)
Entity type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 GENTRY RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70589-4454
Mailing Address - Country:US
Mailing Address - Phone:832-229-3711
Mailing Address - Fax:
Practice Address - Street 1:1307 CROWLEY RAYNE HWY STE B
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-8210
Practice Address - Country:US
Practice Address - Phone:337-783-6857
Practice Address - Fax:337-783-6167
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA215774363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics