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General NPI Number Information
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NPI Number | 1114537537
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Entity Type | Individual
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Provider Name | CASEY LYNN MATTINGLY
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Gender | Female
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Dates
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Enumeration Date | 08/01/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 204 KELLY ST
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City | PARIS
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State | KY
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Zip | 40361-1516
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Country | US
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Telephone | 937-213-0571
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Fax |
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Provider Business Mailing Address
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Address Line | 204 KELLY ST
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City | PARIS
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State | KY
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Zip | 40361-1516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3015429
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 1156767
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License Number State | KY
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