Provider Demographics
NPI:1851529606
Name:MATYSIAK, NICOLE STOCKER (FNP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:STOCKER
Last Name:MATYSIAK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:STOCKER
Other - Last Name:BARTRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2540 N GALLOWAY AVE STE 1032540N
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6306
Mailing Address - Country:US
Mailing Address - Phone:469-294-9655
Mailing Address - Fax:469-300-7260
Practice Address - Street 1:2540 N GALLOWAY AVE STE 103
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4897
Practice Address - Country:US
Practice Address - Phone:469-294-9655
Practice Address - Fax:469-300-7260
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121755363LF0000X
TX793825163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse