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General NPI Number Information
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NPI Number | 1255697975
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Entity Type | Individual
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Provider Name | JAMESON KYLE MATTINGLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2012
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Last Update Date | 12/09/2023
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Provider Practice Location Address
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Address Line | 9430 PARK WEST BLVD STE 330
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City | KNOXVILLE
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State | TN
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Zip | 37923-4203
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Country | US
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Telephone | 865-693-6065
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Fax | 865-531-6325
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Provider Business Mailing Address
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Address Line | 9430 PARK WEST BLVD STE 330
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City | KNOXVILLE
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State | TN
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Zip | 37923-4203
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Country | US
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Telephone | 865-693-6065
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 62735
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | 62735
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License Number State | TN
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