Individual
JOHN MATTHEW FANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1201 PLEASANT VALLEY RD, OWENSBORO, KY 42303-9811
(270) 417-2000
Mailing address
6225 N STATE HIGHWAY 161, STE #200, IRVING, TX 75038-2223
(214) 687-0001
(972) 518-2100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
161179
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
3009983
KY
Other
Enumeration date
12/21/2015
Last updated
12/30/2015
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