Basic Information
| Provider Information | |||||||||
| NPI: | 1598370421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANK | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AGACNP-BC, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 SNOWY EGRET LN | ||||||||
| Address2: | |||||||||
| City: | LEANDER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786411891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125736907 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2400 ROUND ROCK AVE | ||||||||
| Address2: | |||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786814004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123411000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2020 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1012354 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 271072321 | 05 | TX | MEDICAID |