Individual
MIKKLENA M MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1898 FORT RD, SHERIDAN, WY 82801-8320
(307) 672-3473
Mailing address
1898 FORT RD, SHERIDAN, WY 82801-8320
(307) 672-3473
(307) 672-1939
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
AP3293
AZ
363LF0000X
Family Nurse Practitioner
Primary
1146
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100251147-00
—
IA
01
—
254537
MIDLANDS CHOICE FOR IOWA
IA
01
—
254537
MIDLANDS CHOICE FOR NERBASKA
NE
01
—
39139
BCBSNE
NE
01
—
39258
BCBSNE FOR IOWA
IA
Enumeration date
10/19/2006
Last updated
09/14/2021
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