Provider Demographics
NPI:1811481948
Name:YELVERTON, MATTHEW TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TAYLOR
Last Name:YELVERTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 LIBERTY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-3618
Mailing Address - Country:US
Mailing Address - Phone:704-200-8057
Mailing Address - Fax:
Practice Address - Street 1:232 SHARON AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4326
Practice Address - Country:US
Practice Address - Phone:828-758-7091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08164363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant