Provider Demographics
NPI:1265875017
Name:MATRONE, ANDREW KENNETH (ANP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:KENNETH
Last Name:MATRONE
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 TRENWEST DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3211
Mailing Address - Country:US
Mailing Address - Phone:336-993-3146
Mailing Address - Fax:336-992-3930
Practice Address - Street 1:3069 TRENWEST DR
Practice Address - Street 2:STE. 200
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3211
Practice Address - Country:US
Practice Address - Phone:336-993-3146
Practice Address - Fax:336-992-3930
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006048363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003106Medicaid
NC178R6OtherBCBS
NC178R6OtherBCBS