Individual
MR. MATTHEW FULLER IRBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
203 ALLENDALE DR, PORT ALLEN, LA 70767-3219
(225) 389-1311
(225) 683-1310
Mailing address
PO BOX 395, CLINTON, LA 70722-0395
(225) 683-5292
(225) 683-1310
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN134213
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN134213
STATE LICENSE
LA
Enumeration date
07/02/2019
Last updated
07/02/2019
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