Provider Demographics
NPI:1053774794
Name:MATCHEN, TRESSA ANTIONETTE (ARNP-CNP)
Entity type:Individual
Prefix:
First Name:TRESSA
Middle Name:ANTIONETTE
Last Name:MATCHEN
Suffix:
Gender:F
Credentials:ARNP-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-1118
Mailing Address - Country:US
Mailing Address - Phone:580-565-9975
Mailing Address - Fax:888-241-2340
Practice Address - Street 1:CLINIC AT 410 PLLC
Practice Address - Street 2:410 HWY 70 KINGSTON, OK 73439
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439
Practice Address - Country:US
Practice Address - Phone:580-565-9975
Practice Address - Fax:888-241-2340
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily