Clinic at 410 PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

CLINIC AT 410 PLLC

Practice address

410 Hwy 70
Kingston, OK 73439

Phone

(580) 565-9975

Fax

(888) 241-2340

NPI assigned

Jul 1, 2024

Organization subpart

No

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

Authorized official

Name

Tressa Antionette Matchen, NURSE PRACTITIONERNPI 1053774794

Title

FNP-BC

Phone

(580) 565-9975

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tressa Antionette Matchen, ARNP-CNP

  • Family Nurse Practitioner
  • Kingston, OK
  • NPI 1053774794

  Family, OK

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771977600000",
    "number": "1144065012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 HIGHWAY 70 W",
            "city": "KINGSTON",
            "state": "OK",
            "postal_code": "734398237",
            "telephone_number": "580-565-9975",
            "fax_number": "888-241-2340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 HWY 70",
            "city": "KINGSTON",
            "state": "OK",
            "postal_code": "73439",
            "telephone_number": "580-565-9975",
            "fax_number": "888-241-2340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINIC AT 410 PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-01",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A",
        "authorized_official_last_name": "MATCHEN",
        "authorized_official_first_name": "TRESSA",
        "authorized_official_middle_name": "ANTIONETTE",
        "authorized_official_title_or_position": "FNP-BC",
        "authorized_official_telephone_number": "580-565-9975",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bobby J Buckaloo, LPC
• Karen Sue Carr, M.A., LPC
• Meagan Carter
• Elizabeth Caruso, B.S
• Chickasaw Nation
• Roya Cluck, RN
• Craig Michael Couvillon, MD
• Glenda Gene Cross, APRN-CNP
• Dana Boldt Green, M.Ed., LPC, NCGC-2, PC
• Ashley R Davis

• All providers in Kingston, OK
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.