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 1:2698 N GALLOWAY AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6389
Mailing Address - Country:US
Mailing Address - Phone:214-845-6151
Mailing Address - Fax:972-957-2640
Practice Address - Street 1:1650 REPUBLIC PKWY STE 140
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6920
Practice Address - Country:US
Practice Address - Phone:888-382-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX793825163W00000X
TXAP121755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse