Basic Information
| Provider Information | |||||||||
| NPI: | 1467195594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRICO | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1511 HIGHWAY 69 S | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382428636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7313639265 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 284 HIGHWAY 641 N | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383201350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312132446 | ||||||||
| FaxNumber: | 7312132447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363A00000X | 5090 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.