Provider Demographics
NPI:1043557069
Name:MATLOCK, PENNY JAMES (FNP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:JAMES
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 STARTOWN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8307
Mailing Address - Country:US
Mailing Address - Phone:828-327-4745
Mailing Address - Fax:828-322-3569
Practice Address - Street 1:1985 STARTOWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8307
Practice Address - Country:US
Practice Address - Phone:828-327-4745
Practice Address - Fax:828-322-3569
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC145631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily