JENNA M. MATLOCK (NPI# 1215540026) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215540026 |
| Entity Type | Individual |
| Full Name | JENNA M. MATLOCK |
| Other Name | JENNA M. PROVANCE |
| Credential | PA-C |
| Practice Address |
17241 Oak Dr Omaha NE 68130-2428 |
| Mailing Address |
7100 W Center Rd Omaha NE 68106-2714 |
| Practice Telephone | 4028961242 |
| Mailing Telephone | 4025069000 |
| Mailing Fax Number | 4025069093 |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2020-11-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
17241 OAK DR |
| City | OMAHA |
| State | NE |
| Zip Code | 68130-2428 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780297440 | Tayler Marie Llewellyn | Physician Assistant | 17241 Oak Dr, Omaha, NE 68130-2428 | 2020-08-24 |
| 1801403209 | Emily Anna Maguire | Family Medicine | 17241 Oak Dr, Omaha, NE 68130-2428 | 2020-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861998270 | Samantha June Curto | Nurse Practitioner | 17021 Lakeside Drive, Suite 200, Omaha, NE 68130 | 2018-04-04 |
| 1780196451 | Heritage Oncare Home Health LLC | Home Health | 16934 Frances St Ste 200, Omaha, NE 68130 | 2017-11-02 |
| 1497281745 | Dental Professionals of Nebraska, PC | Dentist | 17810 Pierce Plaza, Suite 100, Omaha, NE 68130 | 2017-05-05 |
| 1891166492 | Stephanie Tupper | Speech-Language Pathologist | 16338 Oak Circle, Omaha, NE 68130 | 2015-10-08 |
| 1194036723 | Anthony John Macdissi | Internal Medicine | 16901 Lakeside Hills Court, Attn: Hospital Medicine Dept., Omaha, NE 68130 | 2010-06-29 |
| 1568613305 | Kelly Marie Barkmeier | Occupational Therapist | 1906 South 196th Street, Omaha, NE 68130 | 2008-10-09 |
| 1306009758 | Melissa Sue Loseke | Family Medicine | 17021 Lakeside Hills Plz #200, Omaha, NE 68130 | 2008-07-07 |
| 1477724417 | Denise L. Pollard | Nurse Practitioner | 17525 Gold Plaza Ste 116, Omaha, NE 68130 | 2008-03-18 |
| 1508053943 | Omaha Family Medicine, P.C. | Family Medicine | 17841 Pierce Plz, Omaha, NE 68130 | 2007-10-01 |
| 1669672523 | Jennifer L Liu | Family Medicine | 16909 Lakeside Hills, Ste 300, Omaha, NE 68130 | 2007-07-19 |
| Find all providers in zip 68130 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669745253 | Mary Maureen Garvin | Physician Assistant | Unmc Division of Endocrinology, 983020 Nebraska Medical Center, Omaha, NE 68198-3020 | 2012-02-14 |
| 1508198672 | Brian Barry Nice | Physician Assistant | 987424 Nebraska Medical Ctr, Omaha, NE 68198-7424 | 2010-02-01 |
| 1407014723 | Kylie Michelle Hutsell | Physician Assistant | 11912 Elm St Ste 26, Omaha, NE 68144-4363 | 2008-05-23 |
| 1093995342 | Jennifer Marie Moeller | Physician Assistant | 984120 Nebraska Medical Ctr, Omaha, NE 68198-4120 | 2007-11-04 |
| 1700936978 | Christina M Jensen | Physician Assistant | 7710 Mercy Rd Ste 502, Omaha, NE 68124-2346 | 2007-01-11 |
| 1104984772 | Diana R Lundquist | Physician Assistant | 7815 Farnam Dr, Children's Home Healthcare's World, Omaha, NE 68114-4564 | 2006-12-05 |
| 1528153863 | Mary Patricia Byam-smith | Physician Assistant | 1620 S 198th Ave, Omaha, NE 68130 | 2006-10-03 |
| 1386651172 | Connie L Anderson | Physician Assistant | 105 N 31st Ave, Ste 102, Omaha, NE 68131-2940 | 2006-08-02 |
| 1194731869 | Margaret Alice Antley | Physician Assistant | 710 S 17th St, Omaha, NE 68102-3108 | 2006-08-01 |
| 1033135595 | Heartland Emergicare, P.C. | Physician Assistant | 2429 M Street, Omaha, NE 68107 | 2006-07-15 |
| Find all providers in OMAHA | ||||
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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.