Provider Demographics
NPI:1295273670
Name:BOUNDS, MATTHEW KEVIN (FNP-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KEVIN
Last Name:BOUNDS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-0091
Mailing Address - Country:US
Mailing Address - Phone:601-953-3143
Mailing Address - Fax:
Practice Address - Street 1:821 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-5695
Practice Address - Country:US
Practice Address - Phone:601-809-0882
Practice Address - Fax:601-809-0883
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07583381Medicaid
MS06852808Medicaid