Provider Demographics
NPI:1528562774
Name:MEYERS, MATTHEW A (AANP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:MEYERS
Suffix:
Gender:M
Credentials:AANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 TANNER LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6682
Mailing Address - Country:US
Mailing Address - Phone:865-264-4012
Mailing Address - Fax:
Practice Address - Street 1:120 TANNER LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6682
Practice Address - Country:US
Practice Address - Phone:865-264-4012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily