Healthcare Provider Details

I. General information

NPI: 1912291089
Provider Name (Legal Business Name): TIFFANY NICOLE MATTINGLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CAPITOL AVE STE 1700
LITTLE ROCK AR
72201-3438
US

IV. Provider business mailing address

8 RIVERLYN TER
FORT SMITH AR
72903-2831
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 833-351-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-8867
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: