Provider Demographics
NPI:1780046664
Name:MATTHEWS, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 TEXAS BLVD
Mailing Address - Street 2:406
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5107
Mailing Address - Country:US
Mailing Address - Phone:903-794-4196
Mailing Address - Fax:903-792-7408
Practice Address - Street 1:1002 TEXAS BLVD
Practice Address - Street 2:406
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5107
Practice Address - Country:US
Practice Address - Phone:903-794-4196
Practice Address - Fax:903-792-7408
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130607363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner