Provider Demographics
NPI:1245117175
Name:FOX, MATTHEW MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:FOX
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASS
Mailing Address - State:KS
Mailing Address - Zip Code:67039-8682
Mailing Address - Country:US
Mailing Address - Phone:361-876-3791
Mailing Address - Fax:
Practice Address - Street 1:3535 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8127
Practice Address - Country:US
Practice Address - Phone:316-686-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13153722052163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse