Provider Demographics
NPI:1619233525
Name:CARY, MATTHEW LEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEE
Last Name:CARY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3204
Mailing Address - Country:US
Mailing Address - Phone:314-652-0100
Mailing Address - Fax:314-531-1768
Practice Address - Street 1:3960 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3204
Practice Address - Country:US
Practice Address - Phone:314-652-0100
Practice Address - Fax:314-531-1768
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009515A363L00000X
IL209.011435363L00000X
MO2007022814363L00000X
MO2012005560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner