Provider Demographics
NPI:1245552140
Name:GATLIN, MATTHEW (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GATLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-1101
Mailing Address - Country:US
Mailing Address - Phone:402-879-4781
Mailing Address - Fax:
Practice Address - Street 1:525 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-1101
Practice Address - Country:US
Practice Address - Phone:402-879-4781
Practice Address - Fax:402-879-3365
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06728363A00000X
KS15-01506363A00000X
IA002082363A00000X
NENE1529363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant