Provider Demographics
NPI:1467730531
Name:VINCENT, MATTHEW PAUL (APRN-BC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PAUL
Last Name:VINCENT
Suffix:
Gender:M
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N LAKE ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-5738
Mailing Address - Country:US
Mailing Address - Phone:337-246-7282
Mailing Address - Fax:866-788-0477
Practice Address - Street 1:114 N LAKE ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-5738
Practice Address - Country:US
Practice Address - Phone:337-246-7282
Practice Address - Fax:866-788-0477
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2164252Medicaid