Provider Demographics
NPI:1336264894
Name:MATLOCK, PATRICIA JOANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JOANNE
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HOLDERRIETH
Mailing Address - Street 2:BLVD
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375
Mailing Address - Country:US
Mailing Address - Phone:346-246-3424
Mailing Address - Fax:832-761-7699
Practice Address - Street 1:425 HOLDERRIETH
Practice Address - Street 2:BLVD
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:346-246-3424
Practice Address - Fax:832-761-7699
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX617582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily