Provider Demographics
NPI:1114251238
Name:GILL, MATTHEW TIMMINS (FNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TIMMINS
Last Name:GILL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11610 N 137TH EAST AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-3601
Practice Address - Country:US
Practice Address - Phone:918-928-4180
Practice Address - Fax:918-928-4185
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK118109207Q00000X
OKR0118109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine