Provider Demographics
NPI:1912474479
Name:MATTESON, RYAN PAUL (FNP)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PAUL
Last Name:MATTESON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:STE C
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3844
Mailing Address - Country:US
Mailing Address - Phone:940-626-2110
Mailing Address - Fax:
Practice Address - Street 1:229 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-7205
Practice Address - Country:US
Practice Address - Phone:817-566-0478
Practice Address - Fax:817-566-0484
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX838821363LF0000X
TXAP139501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily