Basic Information
| Provider Information | |||||||||
| NPI: | 1104148626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENT | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | VERNON | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1923 SULPHUR SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378135654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233179344 | ||||||||
| FaxNumber: | 4237142355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1107 N CHARLES G SEIVERS BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CLINTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377163944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659346150 | ||||||||
| FaxNumber: | 8653420150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2010 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN158503 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APN14812 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.