Individual
MR. MATT P. PREWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
2201 S CLEAR CREEK RD, KILLEEN, TX 76549-4110
(254) 519-8871
Mailing address
100 HIGH TRAIL DR, GEORGETOWN, TX 78633-4582
(575) 770-1530
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA08154
TX
363AS0400X
Surgical Physician Assistant
98-PA17
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25070363
—
NM
Enumeration date
06/24/2006
Last updated
04/29/2014
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