Individual
MICHELLE A MATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2600 N LIMESTONE ST STE 150, SPRINGFIELD, OH 45503-1120
(937) 523-9980
(937) 523-9985
Mailing address
2600 N LIMESTONE ST STE 150, SPRINGFIELD, OH 45503-1120
(937) 523-9980
(937) 523-9985
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50003242
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0073726
—
OH
01
—
PA38161
MEDICARE PTAN
OH
Enumeration date
03/17/2011
Last updated
03/27/2026
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