Matthew Clark Fanning, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1-105627 Issued in AL

Practice address

1401 Greensboro Ave
Tuscaloosa, AL 35401-2842

Phone

(205) 391-4000

NPI assigned

May 26, 2025

Last updated

May 26, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Alabama School of Medicine, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Mental Health BD of Bibb Pickens and Tuscaloosa Counties

  dba Indian Rivers MHC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tuscaloosa, AL
  • NPI 1659313393
  NPD

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

{
    "created_epoch": "1748217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748217600000",
    "number": "1699568444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3709 DIAMOND LN",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354732642",
            "telephone_number": "205-792-4167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 GREENSBORO AVE",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354012842",
            "telephone_number": "205-391-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNING",
        "first_name": "MATTHEW",
        "middle_name": "CLARK",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-05-26",
        "last_updated": "2025-05-26",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AL",
            "license": "1-105627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Counseling Service of Tuscaloosa County, Al, Inc. (Family Counseling Service)
• Family Eye Care LLC
• Family Medicine of Tuscaloosa, LLC
• Paige Godfrey Fancher, CRNP
• Tykia Faniel
• Patrick Adam Fanning, FNP-C
• Ahmed Saleh Farah, MD
• Alina Farah
• Jessica Rene Farley
• Iris Leanne Farmer, DIETITIAN

• Psychiatric/Mental Health Nurse Practitioner in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.