Provider Demographics
NPI:1811367139
Name:EARLES, MATTHEW AUSTIN (MSN, MBA, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AUSTIN
Last Name:EARLES
Suffix:
Gender:M
Credentials:MSN, MBA, FNP-BC
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:AUSTIN
Other - Last Name:EARLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, MBA, FNP-BC
Mailing Address - Street 1:PO BOX 173891
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3891
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:729-365-5000
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK102209363LF0000X, 163WE0003X
COAPN.0992714.NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0992714.NPOtherNP LICENSE