Provider Demographics
NPI:1639800717
Name:MATTOCKS, VALERIE KAYE (FNP-BC, AGACNP-BC)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:KAYE
Last Name:MATTOCKS
Suffix:
Gender:F
Credentials:FNP-BC, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 LIMESTONE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7443
Mailing Address - Country:US
Mailing Address - Phone:770-536-8109
Mailing Address - Fax:
Practice Address - Street 1:2324 LIMESTONE OVERLOOK
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7443
Practice Address - Country:US
Practice Address - Phone:770-536-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2024-01-31
Deactivation Date:2022-06-21
Deactivation Code:
Reactivation Date:2022-07-22
Provider Licenses
StateLicense IDTaxonomies
GARN231315363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care