Individual
MATTHEW STEVEN WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 MEDICAL CENTER DR, HAZARD, KY 41701-9421
(506) 439-6600
Mailing address
425 LEWIS HARGETT CIR, LEXINGTON, KY 40503-3590
(859) 268-1030
(859) 269-4120
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1136040
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3015679
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3015679
KENTUCKY BOARD OF NURSING APRN LICENSE
KY
Enumeration date
09/28/2020
Last updated
01/26/2021
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