# CODY MATSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1568974822
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | NP67131 | ID | — |
| 363L00000X | Nurse Practitioner | NP67131 | ID | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | AP60967912 | WA | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | G140540 | IA | — |

## Other

- **Enumeration date:** 10/26/2017
- **Last updated:** 05/20/2024