Provider Demographics
NPI:1821826595
Name:SPUDY, MATTHEW BRYAN (FNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRYAN
Last Name:SPUDY
Suffix:
Gender:
Credentials:FNP
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 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-300-4500
Mailing Address - Fax:910-675-3030
Practice Address - Street 1:7910 US HWY 117 S UNIT 120
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NC
Practice Address - Zip Code:28457-7409
Practice Address - Country:US
Practice Address - Phone:910-300-4500
Practice Address - Fax:910-550-3787
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020522363LF0000X, 363L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program