Provider Demographics
NPI:1639692965
Name:RICH, MATTHEW STEVEN (MSN, RN, AGCNS-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEVEN
Last Name:RICH
Suffix:
Gender:M
Credentials:MSN, RN, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4010 CLOVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9314
Mailing Address - Country:US
Mailing Address - Phone:480-242-7129
Mailing Address - Fax:
Practice Address - Street 1:2323 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7747
Practice Address - Country:US
Practice Address - Phone:903-597-1351
Practice Address - Fax:903-597-1351
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134553364SG0600X
TX880140163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381371901Medicaid