Provider Demographics
NPI:1700151396
Name:MCCAULEY, MATTHEW TOBIAS (CRNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TOBIAS
Last Name:MCCAULEY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2421
Mailing Address - Country:US
Mailing Address - Phone:256-259-5313
Mailing Address - Fax:256-259-4923
Practice Address - Street 1:13624 COUNTY ROAD 8
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:AL
Practice Address - Zip Code:35776-6162
Practice Address - Country:US
Practice Address - Phone:256-776-5615
Practice Address - Fax:256-776-5617
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126825363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51128618OtherBC/BS OF ALABAMA
AL145163Medicaid
AL142430Medicaid
AL1700151396OtherTRICARE
AL142430Medicaid