Provider Demographics
NPI:1386207306
Name:MATTHEWS, WANDA (NP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2710 NOGALITOS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78225-1750
Mailing Address - Country:US
Mailing Address - Phone:210-436-8400
Mailing Address - Fax:833-452-1052
Practice Address - Street 1:5301 ALAMO PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6771
Practice Address - Country:US
Practice Address - Phone:210-688-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1051287363LF0000X
IL209018804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner