Provider Demographics
NPI:1982415766
Name:ALLRED, MATTHEW WADE
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WADE
Last Name:ALLRED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 OLD STERLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2396
Mailing Address - Country:US
Mailing Address - Phone:318-324-1414
Mailing Address - Fax:
Practice Address - Street 1:4400 OLD STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2396
Practice Address - Country:US
Practice Address - Phone:318-324-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASTUDENT363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily