CLINIC AT 410 PLLC
NPI 1144065012
Nurse Practitioner - Family in Kingston, OK
About Clinic At 410 Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CLINIC AT 410 PLLC (NPI 1144065012) is a healthcare organization registered as a family in Kingston, Oklahoma and active in the NPI registry since July 2024. The organization holds a CLIA Waiver certificate valid through July 29, 2028 and lists Tressa Antionette Matchen, Fnp-bc, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Clinic At 410 Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Clinic At 410 PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Kingston, OK 73439
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 37D2308503
Clinic At 410 PLLC · Kingston, OKFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Clinic At 410 PLLC's NPI number?
The NPI number for Clinic At 410 PLLC is 1144065012. It was assigned to this organization in the NPPES registry on July 1, 2024.
Where is Clinic At 410 PLLC located?
Clinic At 410 PLLC is located at 410 Hwy 70, Kingston, OK 73439. The listed phone number is (580) 565-9975.
What is Clinic At 410 PLLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Clinic At 410 PLLC enrolled in Medicare?
Yes. Clinic At 410 PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Clinic At 410 PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Clinic At 410 PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Clinic At 410 PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 37D2308503) is associated with this NPI, valid through July 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Clinic At 410 PLLC accept?
Health plans from Blue Cross and Blue Shield of Oklahoma list Clinic At 410 PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Clinic At 410 PLLC was last updated on February 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Clinic At 410 Pllc · NPI 1144065012
Family organization in Kingston, Oklahoma. Organization record, active in the CMS NPPES registry since July 1, 2024.
## Identity
- **NPI:** 1144065012 (Entity type: Organization)
- **Enumerated:** July 1, 2024
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Tressa Matchen, FNP-BC
## Practice location
- **Address:** 410 HWY 70, Kingston, OK 73439
- **Phone:** (580) 565-9975 · **Fax:** (888) 241-2340
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 25, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1144065012) · Data from the CMS NPPES public registry.