MICHELE LEE MATLOCK (NPI# 1316134851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1316134851 |
Entity Type | Individual |
Full Name | MICHELE LEE MATLOCK |
Credential | M.S., PA-C |
Practice Address |
1600 Providence Dr Waco TX 76707-2261 |
Practice Telephone | 2543134200 |
Practice Fax Number | 2543134531 |
Mailing Telephone | 2543134200 |
Mailing Fax Number | 2543134531 |
Enumeration Date | 2007-09-28 |
Last Update Date | 2013-11-25 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA01063 | TX | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
1600 PROVIDENCE DR |
City | WACO |
State | TX |
Zip Code | 76707-2261 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912900531 | Matthew Rafalski | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2005-05-27 |
1083228621 | Jourdan Brown Whorley | Physician Assistant | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-09-01 |
1538778543 | Hilda Ana Deen | Nurse Practitioner | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-07-26 |
1427673128 | Allison Dawn Thompson | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
1245855949 | Thien Phu Nguyen | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
1134744824 | William Casey Dean | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
1306461090 | Corey Ryan Holt | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
1821613514 | Kathryn Leah Kline | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
1346865037 | Michael Thomas Boone | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
1295350999 | Amanda Elizabeth Weaver | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588184493 | Yukiyo Shimosawa | Specialist/Technologist | 1010 N 17th St, Waco, TX 76707 | 2017-06-21 |
1851730022 | Krystal Ann Estrada | Family Medicine | 1600 Providence Drive, Waco, TX 76707 | 2013-06-20 |
1598902744 | Narconon Hawaii | Substance Abuse Rehabilitation Facility | 90-1011 Lexington Avenue, Kapolei, HI 76707 | 2009-01-09 |
1851413520 | Albert Bryan Lewter Jr. | Dentist | 1501 N 25th St, Waco, TX 76707 | 2007-04-04 |
1114010733 | Remmel Henry | Dentist | 225 W. West Waco Dr., Waco, TX 76707 | 2006-10-02 |
1861831034 | Ryan David Laschober | Family Medicine | 1600 Providence Drive, Waco, TX 76707 | 2013-06-20 |
1760821946 | Brandi Escalante Street | Family Medicine | 1600 Providence Drive, Waco, TX 76707 | 2013-06-20 |
1972778199 | Jason Craig | Counselor | 3621 Lasker Ave, Waco, TX 76707-1111 | 2008-04-29 |
1649831298 | Melanie Adams | Social Worker | 3617 Maple Ave, Waco, TX 76707-1117 | 2019-06-25 |
1538721246 | Jessica Marie Simon | Nurse Practitioner | 3613 Trice Ave, Waco, TX 76707-1127 | 2019-07-02 |
Find all providers in zip 76707 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619494226 | Ariel Rennspies | Physician Assistant | 1135 Tx-340 Loop, Waco, TX 76705 | 2017-08-24 |
1689729493 | Sarah Elaine Ranzinger | Physician Assistant | 601 W Hwy 6 Ste 105, Waco, TX 76710-5592 | 2007-01-24 |
1083228621 | Jourdan Brown Whorley | Physician Assistant | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-09-01 |
1922534478 | Lina Ancha | Physician Assistant | 405 Londonderry Dr Ste 310, Waco, TX 76712-7922 | 2017-05-03 |
1093188831 | Katelyn Dvorsky | Physician Assistant | 6101 Woodway Dr, Waco, TX 76712-6111 | 2015-11-02 |
1558741967 | Fernando Galindo | Physician Assistant | 7700 Fish Pond Rd, Waco, TX 76710-1031 | 2015-06-02 |
1538419395 | Meghan Marie Ruscitto | Physician Assistant | 6901 Medical Pkwy, Waco, TX 76712-7910 | 2012-09-19 |
1255689881 | Kayla Renee Davis | Physician Assistant | 6600 Fish Pond Rd, Suite 202a, Waco, TX 76710-2581 | 2012-08-29 |
1538398458 | Joseph Edward Justice I | Physician Assistant | 4800 Memorial Dr, Waco, TX 76711-1329 | 2009-07-13 |
1285888768 | Jenny Louetta Nelson | Physician Assistant | 7003 Woodway Dr, Suite 311, Waco, TX 76712-6170 | 2008-11-10 |
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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.