Provider Demographics
NPI:1235742644
Name:DUKE, MATTHEW (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DUKE
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2127
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-2127
Mailing Address - Country:US
Mailing Address - Phone:602-481-1684
Mailing Address - Fax:
Practice Address - Street 1:1500 E WOOLFORD RD STE 101
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7105
Practice Address - Country:US
Practice Address - Phone:928-251-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235206363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care