Provider Demographics
NPI:1720363138
Name:YELKEN, MATTHEW KEITH (PA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:KEITH
Last Name:YELKEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 SW 41ST ST
Mailing Address - Street 2:APT. 2304
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7449
Mailing Address - Country:US
Mailing Address - Phone:386-984-0003
Mailing Address - Fax:
Practice Address - Street 1:1901 SE 18TH AVE
Practice Address - Street 2:#400
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8215
Practice Address - Country:US
Practice Address - Phone:352-732-8905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant