Jody Kaye Matlock, MPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103793 Issued in NC

Practice address

1107 Reynolds St
Monroe, NC 28112-4351

Phone

(704) 289-8220

Fax

(704) 289-9195

NPI assigned

Jun 30, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cornerstone Ear Nose & Throat PA

  • Otolaryngology Physician
  • Indian Land, SC
  • NPI 1932800745
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013946342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 REYNOLDS ST",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281124351",
            "telephone_number": "704-289-8220",
            "fax_number": "704-289-9195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 REYNOLDS ST",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281124351",
            "telephone_number": "704-289-8220",
            "fax_number": "704-289-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATLOCK",
        "first_name": "JODY",
        "middle_name": "KAYE",
        "credential": "MPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Monroe, NC
• Providers in Monroe, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.