Provider Demographics
NPI:1467195594
Name:CARRICO, MATTHEW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:CARRICO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 HIGHWAY 69 S
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-8636
Mailing Address - Country:US
Mailing Address - Phone:731-363-9265
Mailing Address - Fax:
Practice Address - Street 1:284 HIGHWAY 641 N
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1350
Practice Address - Country:US
Practice Address - Phone:731-213-2446
Practice Address - Fax:731-213-2447
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-17
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 390200000X
TN5090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program