Provider Demographics
NPI:1598052870
Name:PURTLE, MATTHEW GLENN (APA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GLENN
Last Name:PURTLE
Suffix:
Gender:M
Credentials:APA-C
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Mailing Address - Street 1:5701 W 119TH ST STE 410
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3721
Mailing Address - Country:US
Mailing Address - Phone:913-345-6901
Mailing Address - Fax:913-469-4095
Practice Address - Street 1:8919 PARALLEL PKWY STE 270
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1655
Practice Address - Country:US
Practice Address - Phone:913-788-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2022-01-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN