MR. MATTHEW BRISTER (NPI# 1154816098) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154816098 |
| Entity Type | Individual |
| Full Name | MR. MATTHEW BRISTER |
| Practice Address |
1555 Exchange Ave Conway AR 72032-7824 |
| Mailing Address |
45 Persimmon Ridge Dr Greenbrier AR 72058-8818 |
| Practice Telephone | 7137934603 |
| Mailing Telephone | 9795495044 |
| Enumeration Date | 2018-06-23 |
| Last Update Date | 2020-07-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
124193 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP137814 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1555 EXCHANGE AVE |
| City | CONWAY |
| State | AR |
| Zip Code | 72032-7824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629052931 | Thomas Gene Alfano | Anesthesiology | 1555 Exchange Ave, Conway, AR 72032-7824 | 2005-11-30 |
| 1255851515 | Brett Alan Morris | Nurse Practitioner | 1555 Exchange Ave, Conway, AR 72032-7824 | 2017-06-27 |
| 1720508195 | Sheza Tauheed Khawaja | Internal Medicine | 1555 Exchange Ave, Conway, AR 72032-7824 | 2017-06-26 |
| 1275084188 | Conway Community Services | Radiology | 1555 Exchange Ave, Conway, AR 72032-7824 | 2016-10-17 |
| 1669922308 | Teryn Denae Laseter | Personal Emergency Response Attendant | 1555 Exchange Ave, Conway, AR 72032-7824 | 2016-10-05 |
| 1083163638 | Lance Kennedy Harris | Physician Assistant | 1555 Exchange Ave, Conway, AR 72032-7824 | 2016-09-23 |
| 1699221853 | Lachan Elizabeth Siebenmorgen | Physician Assistant | 1555 Exchange Ave, Conway, AR 72032-7824 | 2016-08-28 |
| 1790147106 | Conway Community Services | Rehabilitation Unit | 1555 Exchange Ave, Conway, AR 72032-7824 | 2016-03-24 |
| 1609258938 | Hira Cheema | Internal Medicine | 1555 Exchange Ave, Conway, AR 72032 | 2015-06-23 |
| 1760820583 | Megan Taylor | Emergency Medicine | 1555 Exchange Ave, Conway, AR 72032-7824 | 2013-06-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730789843 | Amelia S Lasater | Pharmacist | 1155 Hwy 65n, Conway, AR 72032 | 2020-10-28 |
| 1619584604 | Danyelle Durocher | Occupational Therapist | 1301 North Museum Rd, Conway, AR 72032 | 2020-09-24 |
| 1780222174 | Eric Herman Boxnick | Pharmacist | 101 West Oak Street, Conway, AR 72032 | 2019-12-16 |
| 1932746070 | Habilitation Center, LLC | Psychiatric Residential Treatment Facility | 161 Skunk Hollow Road, Conway, AR 72032 | 2019-12-09 |
| 1679051668 | Mary Elizabeth Black | Nurse Practitioner | 222 Dave Ward Drive, Conway, AR 72032 | 2018-08-01 |
| 1275035602 | Conway Dental Center Pllc | Dentist | 1600 E. Oak Street Suite B, Conway, AR 72032 | 2018-03-01 |
| 1750821625 | Luke Osborne | Physical Therapy Assistant | 1 Thomas Ln, Conway, AR 72032 | 2017-02-27 |
| 1639620099 | Sam's West, Inc. | Technician/Technologist | 1250 South Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1922559343 | Sam's West, Inc. | Durable Medical Equipment & Medical Supplies | 1250 Sourth Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1639629108 | Posture Store | Durable Medical Equipment & Medical Supplies | 3900 Dave Ward Dr., Suite 1900-130, Conway, AR 72032 | 2016-10-09 |
| Find all providers in zip 72032 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023617594 | Mckenzie Lauren Cotton | Nurse Practitioner | 1065 Skyline Dr, Conway, AR 72032-3530 | 2020-10-25 |
| 1316566607 | Shannon Busby | Nurse Practitioner | 1505 Winterbrook Dr, Conway, AR 72034-3564 | 2020-04-16 |
| 1538798087 | Glenda Darlene Gore | Nurse Practitioner | 17 Kali Ct, Conway, AR 72032-9477 | 2020-04-06 |
| 1265071427 | Dana Aysha Niederhauser | Nurse Practitioner | 1250 Littlewood Cv, Conway, AR 72032-8986 | 2020-01-04 |
| 1285287680 | Joy Griffith | Nurse Practitioner | 2907 Percy Cir, Conway, AR 72034-5508 | 2019-07-24 |
| 1366094260 | Kerry Kathryn Lewis | Nurse Practitioner | 1910 Royal Dr, Conway, AR 72034-7346 | 2019-07-10 |
| 1487113148 | Laura B Kelly | Nurse Practitioner | 2300 Linda Dr, Conway, AR 72032-8999 | 2019-03-12 |
| 1780141069 | Ashleigh Lynn Kinon | Nurse Practitioner | 2065 Woodlawn Dr, Conway, SC 29526-7703 | 2019-02-22 |
| 1679051668 | Mary Elizabeth Black | Nurse Practitioner | 222 Dave Ward Drive, Conway, AR 72032 | 2018-08-01 |
| 1780191015 | Sydnie Thessing | Nurse Practitioner | 605 Dave Ward Drive #105, Conway, AR 72034 | 2018-01-09 |
| Find all providers in CONWAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.