Provider Demographics
NPI:1205728094
Name:DANIEL, MATTHEW TODD (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TODD
Last Name:DANIEL
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 E DORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAFFORDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41256-9128
Mailing Address - Country:US
Mailing Address - Phone:606-793-7239
Mailing Address - Fax:
Practice Address - Street 1:513 E DORTON BLVD
Practice Address - Street 2:
Practice Address - City:STAFFORDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41256-9128
Practice Address - Country:US
Practice Address - Phone:606-793-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4043423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner