Provider Demographics
NPI:1639800717
Name:MATTOCKS, VALERIE KAYE (FNP-BC, AGACNP-BC)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:KAYE
Last Name:MATTOCKS
Suffix:
Gender:
Credentials:FNP-BC, AGACNP-BC
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 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:378 MARKETPLACE PKWY
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-7266
Practice Address - Country:US
Practice Address - Phone:678-389-6509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2025-03-18
Deactivation Date:2022-06-21
Deactivation Code:
Reactivation Date:2022-07-22
Provider Licenses
StateLicense IDTaxonomies
GARN231315363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care