Provider Demographics
NPI:1134904675
Name:FLEMING, MATTHEW BLAKE (FNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BLAKE
Last Name:FLEMING
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 HIGHWAY 43 S
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-7415
Mailing Address - Country:US
Mailing Address - Phone:769-242-2525
Mailing Address - Fax:
Practice Address - Street 1:2416 HIGHWAY 43 S STE B
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-7462
Practice Address - Country:US
Practice Address - Phone:769-242-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS894301163WC0200X
MS906539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine